Diagnosis and management of chronic radiation enteritis
- Ingram Roberts, MD, MBA
Ingram Roberts, MD, MBA
- Clinical Professor of Medicine (Adjunct)
- Temple University School of Medicine
- Section Editors
- J Thomas Lamont, MD
J Thomas Lamont, MD
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — Anorectal Disorders and Misc. Lower GI Disease; Nutrition, Malabsorption, and Misc. Upper GI Disease
- Professor of Medicine
- Harvard Medical School
- Christopher G Willett, MD
Christopher G Willett, MD
- Section Editor — Radiation Therapy
- Duke University Medical School
Injury to the intestines can occur following radiation therapy for cancer. It can affect both the large and small intestines, is often progressive, and may lead to a variety of clinical consequences depending upon the extent of the injury. It usually develops three or more months after radiation therapy. Chronic radiation enteritis is due to an obliterative arteritis that leads to intestinal ischemia, which can result in stricture, ulceration, fibrosis, and occasionally fistula formation. The physiologic consequences can include altered intestinal transit, reduced bile acid absorption, increased intestinal permeability, bacterial overgrowth, and lactose malabsorption. Clinical manifestations include nausea, vomiting, abdominal pain, diarrhea, weight loss, malnutrition, and bleeding (usually in patients with colonic involvement).
This topic review will focus on the diagnosis and management of chronic radiation injury to the small intestine and proximal colon. The pathogenesis, clinical manifestations, and risk factors for chronic radiation enteritis and other radiation-related gastrointestinal toxicities are discussed separately. (See "Overview of gastrointestinal toxicity of radiation therapy" and "Clinical manifestations, diagnosis, and treatment of radiation proctitis".)
The diagnosis of chronic radiation enteritis is suspected in patients with nausea, vomiting, abdominal pain, diarrhea, or lower gastrointestinal bleeding three or more months after completion of radiation therapy. The diagnosis is usually established by segmental bowel inflammation in regions of a known radiation field on imaging or by endoscopy and histology.
Diagnostic approach — Evaluation of a patient with suspected chronic radiation enteritis serves to exclude other causes of etiologies, establish the diagnosis of chronic radiation, and determine the extent of the disease.
●The patient's prior radiation treatment should be reviewed to determine the cumulative dose, dose per fraction, proximity of sensitive tissues and organs, and other cancer treatments (eg, abdominal surgery, concurrent chemotherapy) that can increase the risk of radiation enteritis. This may help to determine which intestinal segments may have received excessive radiation exposure, which can then be correlated with the radiologic findings and the clinical presentation.
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