Edit concept Question Editor Create issue ticket

Radiation Esophagitis

Esophagitis Irradiation

Radiation esophagitis is a potential complication of radiation therapy mainly seen in malignancies of the chest, most notably the lungs. Acute and chronic forms are described in the literature. In the acute setting, symptoms in the form of odynophagia and dysphagia appear a few weeks after initiating radiation therapy, whereas months or years may pass before the onset of complaints in chronic radiation esophagitis. The diagnosis is made through a comprehensive clinical assessment and imaging studies, endoscopy being the gold standard for esophageal examination.


Presentation

Radiation esophagitis is by many authors divided into two forms - acute and chronic [1] [2] [3] [4]. Acute radiation esophagitis is defined as the onset of esophageal-related symptoms as a response to radiation therapy (RT) within 3 weeks [1] [2] [3] [4]. Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss [1] [2] [4]. Pain in the substernal region and discomfort is also seen in many patients, developing on the grounds of inflammatory changes occurring in the esophageal mucosa [1] [2]. The severity of the associated features strongly correlates with the radiation dose (more pronounced signs are seen with higher doses), a more advanced tumor stage, increased age, and the presence of adjuvant chemotherapy (bleomycin, vincristine, cyclophosphamide, actinomycin, and daunorubicin) [1] [2] [3] [5]. Some patients may not be able to swallow any food and thus require a feeding tube and/or total parenteral nutrition [2]. On the other hand, chronic radiation esophagitis occurs when at least three months pass from RT to the onset of the signs of the ailment, but the majority of patients report around 6-12 months [1] [2] [4]. The formation of esophageal strictures from fibrotic changes is the main factor for the development of symptoms in these patients, most important being progressive dysphagia, associated swallowing difficulties, and impaired mobility of the esophagus [1] [2].

Dentist
  • Some patients receiving radiation treatments to the mouth may be referred to a dentist, and most patients will also be referred to a registered dietitian.[my.clevelandclinic.org]
  • It was a while ago so I can't remember the name of the products I used but I got a saliva gel from my dentist kept the area from getting too dry. I also used and oral spray that numbed the area, got that from my chemist.[onlinenetwork.bcna.org.au]
Plethora
  • The plethora of rapidly dividing cells in the gastrointestinal tract makes the tract particularly vulnerable to cytotoxic chemotherapeutic agents [ 11 ].[ro-journal.biomedcentral.com]
Odynophagia
  • Most commonly reported complaints are nausea, odynophagia, dysphagia, and anorexia that can promote significant weight loss.[symptoma.com]
  • Patients typically present with nonspecific symptoms such as dysphagia and odynophagia. Endoscopic changes such as erythema and ulceration are also nonspecific and nondiagnostic.[ncbi.nlm.nih.gov]
  • , Topical anesthetics or NSAIDs, Soft diet Moderate dysphagia or odynophagia, Narcotic analgesics, Puree or liquid diet Severe dysphagia or odynophagia, Dehydration or weigh loss 15%, IV fluids, NGT, TPN Complete obstruction, ulceration, perforation,[en.wikibooks.org]
  • Patients with dysphagia, odynophagia, weight loss, and/or anemia should undergo endoscopy in a facilitated manner because of a higher risk of malignancy. Video Endoscopic Sequence 3 of 4.[gastrointestinalatlas.com]
Gagging
  • This mixture can suppress a persons gag reflex; therefore patients should eat slowly and sit upright for at least 30 minutes after eating to prevent aspiration. Appropriate antibiotic or anti- fungal for infection.[oncolink.org]
  • Usually it lasts about a month after you finish. best wishes x LMK74 Brisbane Member Posts: 775 Hi @JoeyLiz, they did recommend the soluble panadol but I gag on the taste of it. I have been prescribed ordine but yet to fill it.[onlinenetwork.bcna.org.au]
  • In patients in whom a cycle of gagging can develop from the thickness of the secretions, lorazepam is useful. A cool mist vaporizer can also help, although if used at home proper cleaning must occur to prevent pseudomonas contamination.[clinicaladvisor.com]
Deglutition Disorder
  • Disorders Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Neoplasms Lung Diseases Respiratory Tract Diseases Esophageal Diseases Gastrointestinal Diseases Digestive System Diseases Gastroenteritis Pharyngeal Diseases Otorhinolaryngologic[clinicaltrials.gov]
Choking
  • However, several years ago, I had continued choking on food, and dr. had me have a bariumstudy to observe food passing through esophagus and further. "Swallow Test.".[community.breastcancer.org]
Chest Pain
  • Chest pain of esophageal origin cannot be accurately distinguished from chest pain associated with coronary artery disease (CAD). Therefore, prehospital protocols should be followed for the management of chest pain potentially caused by CAD.[emedicine.medscape.com]
  • In Erridge 2005 , the 30Gy/10F regimen was significantly better at reducing chest pain and dyspnoea compared to 10Gy/1F.[cochranelibrary.com]
  • (if reflux post stent placement is defined as a complication) Prolonged chest pain caused by stent expansion is more common with larger and more flared stents.case reports of erosion of the stents into the airway or adjacent vascular structures, which[slideshare.net]
  • Patients may present with heartburn, dysphagia, odynophagia, food impaction, weight loss, and chest pain. Progressive dysphagia for solids is the most common presenting symptom. This may progress to include liquids.[gastrointestinalatlas.com]
  • Some studies identify smoking as a risk for pneumonitis, 19 whereas others suggest smoking may lessen the risk. 20 Symptoms of radiation pneumonitis, including low-grade fever, congestion, dry cough, pleuritic chest pain, and a sensation of chest fullness[aafp.org]
Suggestibility
Fear
  • […] idea to invest a few minutes to endoscopically evaluate the final resting place of the proximal end of the stent and ensure its adequate expansion.However, endoscopists should resist the temptation to pass a conventional endoscope through the stent for fear[slideshare.net]

Workup

The initial diagnosis of radiation esophagitis is made through a properly obtained patient history. Physicians must identify prior radiation therapy (implying that information about the underlying illness must also be collected) and a distinction between acute and chronic can be made based on the onset, course, and progression (as well as severity) of findings. The physical examination should focus on excluding oral candidiasis (through inspection of the oral cavity), recurrence of the primary disease (by palpating proximal lymph nodes) and aspiration pneumonia (through lung auscultation) [2]. Although the condition can be identified solely on clinical grounds, imaging studies should be employed to solidify suspicion [2]. Barium swallowing test is useful for detecting strictures and abnormal peristalsis, computed tomography (CT) is indicated for evaluation of disease recurrence and detection of a possible fistula, but endoscopy is regarded as the gold standard for esophageal assessment [1] [2]. In addition to strictures, typical findings on endoscopy include erosions, erythema, ulceration, and even hemorrhage, but the severity of esophageal damage may not always correlate with reported symptoms [1] [2]. Histology can be useful, particularly when opportunistic infections compromise the diagnosis, showing chronic inflammatory changes and extensive fibrosis [1] [2].

Multiple Ulcerations
  • The image displays the cardias with multiple ulcers. Alcohol. Heavy drinking can cause patchy inflammatory erythema of the esophageal mucosa. With abstinence, these changes are quickly and completely reversible. Video Endoscopic Sequence 2 of 2.[gastrointestinalatlas.com]

Treatment

  • Abstract The esophagus is frequently exposed to radiation during treatment of advanced stages of common cancers such as lung, breast, and esophagus.[ncbi.nlm.nih.gov]
  • Secondary Outcome Measures : Radiation Esophagitis-related Pain During Treatment as Measured During Treatment and 12 Weeks by the Numerical Rating Pain Scale (NRPS) [ Time Frame: Baseline, weekly during treatment, and 12 weeks from the start of treatment[clinicaltrials.gov]
  • The lining of your esophagus (food pipe) is sensitive to radiation and may become inflamed and sore during treatments (a condition called esophagitis ).[my.clevelandclinic.org]

Prognosis

  • Normally, the prognosis would be good with no serious illnesses. If there are more causes than one, the prognosis could move to fair.[en.wikipedia.org]
  • A total score based on these factors was able to separate patients with a poor, intermediate or relatively good prognosis ( Table 1 ).[nature.com]
  • Prognosis for esophagitis is normally good. Esophagitis can be caused by certain allergies. Being overweight increases the risk of esophagitis. Depending on the cause of esophagitis, there are various possible treatments.[medicalnewstoday.com]
  • Esophageal cancer has a poor prognosis if advanced cancer is diagnosed, but the prognosis of patients with superficial esophageal cancer is acceptable.[spandidos-publications.com]
  • PS is a well known major determinant of prognosis in these patients.[cochranelibrary.com]

Etiology

  • Aged Carcinoma, Non-Small-Cell Lung/pathology Carcinoma, Non-Small-Cell Lung/therapy* Carcinoma, Squamous Cell/pathology Carcinoma, Squamous Cell/therapy Chemoradiotherapy/adverse effects Chemoradiotherapy/methods* Chi-Square Distribution Esophagitis/etiology[ncbi.nlm.nih.gov]
  • Jump to navigation Jump to search Radiation Toxocity: Esophagus Etiology [ edit ] Dysphagia disordered eating potentially caused by a number of mechanisms, both neurologic and non-neurologic Odynophagia painful swallowing Swallowing process includes three[en.wikibooks.org]
  • Another etiology (steroid-induced gastritis) should be sought and treated. Radiation pneumonitis is always a diagnosis of exclusion.[clinicaladvisor.com]
  • The utility of intralesional injections for strictures with a different etiology needs further elucidation.[nature.com]
  • Endoscopy is indicated to: Determine the underlying etiology. Exclude malignant&premalignant conditions. Assess the need for therapy. Perform therapy, such as dilation.[slideplayer.com]

Epidemiology

  • CA Cancer J Clin 2013, 63: 11-30. 10.3322/caac.21166 View Article PubMed Google Scholar Youlden DR, Cramb SM, Baade PD: The International Epidemiology of Lung Cancer: geographical distribution and secular trends.[ro-journal.biomedcentral.com]
  • Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009 Oct. 7(10):1055-61. [Medline]. Nurko S, Rosen R, Furuta GT.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Unlike others on this topic, this text demonstrates how the endoscope incorporates pathophysiology, diagnostic, and treatment modalities into endoscopic practice.[books.google.com]
  • Clinical, pathophysiologic and radiobiologic aspects”. A review. Acta Oncol. vol. 29. 1990. pp. 401-15. Lutz, ST, Chow, EL, Hartsell, WF, Konski, AA. “A review of hypofractionated palliative radiotherapy”. Cancer. vol. 109. 2007 Apr 15. pp. 1462-70.[clinicaladvisor.com]
  • Pathophysiology: Reflux esophagitis develops when gastric contents are passively regurgitated into the esophagus. acid, pepsin, and bile irritate the squamous epithelium, leading to erosion and ulceration of esophageal mucosa.[gastrointestinalatlas.com]
  • . - The pathophysiology behind the sclerosis, fibrosis and atrophy is not well understood. Some believe there is a link between vascular endothelial damage and the progression of the fibrosis.[physio-pedia.com]

Prevention

  • OBJECTIVE: To systematically assess the clinical effectiveness of Chinese medicines for prevention and treatment of radiation esophagitis by meta-analysis.[ncbi.nlm.nih.gov]
  • Special chapters, such as the Designing Clinical Research in Gastrointestinal Endoscopy, The Prevention of Infection Following Gastrointestinal Endoscopy, Complications of Peptic Ulcer Disease, and Credentialing for Gastrointestinal Endoscopy, help make[books.google.com]

References

Article

  1. Murro D, Jakate S. Radiation esophagitis. Arch Pathol Lab Med. 2015;139(6):827-830.
  2. Baker S, Fairchild A. Radiation-induced esophagitis in lung cancer. Lung Cancer (Auckl). 2016;7:119-127.
  3. Bar-Ad V, Ohri N, Werner-Wasik M. Esophagitis, treatment-related toxicity in non-small cell lung cancer. Rev Recent Clin Trials. 2012;7(1):31–35.4
  4. Berkey FJ. Managing the adverse effects of radiation therapy. Am Fam Physician. 2010;82(4):381-388, 394.
  5. Ahn S, Kahn D, Zhou S, et al. Dosimetric and clinical predictors for radiation-induced esophageal injury. Int J Radiat Oncol Biol Phys. 2005;61(2):335–347.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 20:55