Chronic Radiation Enteritis Research Articles

Chronic Radiation Enteritis: Women's Food Tolerances After Radiation Treatment for Gynecological Cancer

LEARNING OUTCOME: To identify foods that commonly affect bowel activity after abdominal radiotherapy. Chronic Radiation Enteritis (CRE) can occur in patients who receive abdominal radiotherapy (ART). The literature suggests low residue, low fat, and low lactose diets in the management of CRE symptoms but does not provide definitive guidelines. Twenty-six women with documented CRE and 21 with no documentation of CRE (control group) completed a nutrition questionnaire developed by a Registered Dietitian/Nutritionist. The questionnaire sought to identify specific foods that affected bowel symptoms after ART. Seventy percent of the CRE group identified excess bloating, gas, abdominal cramps and diarrhea post ART compared to 24% of the control group. Fifty percent of the CRE patients reported an increase in symptoms upon consumption of bran muffins, berries, cabbage, brussel sprouts, broccoli, tossed salad, caesar salad, baked beans, lentils, and nuts in contrast to 14% of the controls. A significant difference was seen in the portion sizes of these foods tolerated between the two groups. Eighty-five percent of the CRE group could only tolerate very small portions of these foods (less than a diabetic food exchange) while the controls consumed large portions before symptom exacerbation. In conclusion, smaller, more frequent portions of foods are better tolerated and an individualized approach is critical in the nutritional management of CRE.

Description of the Chronic Radiation Syndrome in Humans Irradiated in the Former Soviet Union

The purpose of this letter is to call attention to the availability of a technical report on the chronic radiation syndrome (CRS) which may be obtained from the Armed Forces Radiobiology Research Institute (AFRRI). Pursuant to facilitating communications between radiation scientists in the United States and the former Soviet Union, AFRRI and the Defense Nuclear Agency (DNA) have provided small amounts of funding for scientists in the former Soviet Union to conduct pilot experiments or to pursue critical archiving documentation and/or analysis of existing data. The overarching goal was to augment the process whereby important newly available data or ideas could be communicated outside the former Soviet Union for evalua-

Cigarette smoking and NSAID use increase the risk of chronic radiation enteritis: N. Shenoy, M. Pritchard, and [formula omitted]. Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC

Cigarette smoking and NSAID use increase the risk of chronic radiation enteritis: N. Shenoy, M. Pritchard, and [formula omitted]. Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC

Radiation-Induced Intestinal Injury

Radiation therapy is administered to approximately one third of patients with cancer as part of their treatment plan. Radiation-induced bowel injury is a major cause of morbidity in these patients. The pathophysiology of this condition as well as recommendations for the management of acute and chronic radiation enteritis are discussed. In general, except for patients presenting with signs of an acute abdomen, conservative management yields the best clinical results.

Strahlungsenteritis (Übersicht)

The clinical and radiological findings in chronic radiation enteritis are described in a group of 18 patients. The patients presented with malabsorption, diarrhoea, chronic intermittent obstruction or a combination of these signs. Eventually all patients developed an ileus. The radiologist plays an important role in determining the cause of the clinical signs. The single-contrast barium infusion technique was used. In the jejunum no changes were found except bowel dilatation as a sign of an obstruction more distally. In the ileum there was evidence of submucosal thickening, adhesions and single or multiple stenoses. These changes are described in relation to the pathogenesis of chronic radiation enteritis.

Chronic radiation enteritis: a community hospital experience.

A retrospective study was undertaken to evaluate the operative management of patients with chronic radiation enteropathy. Thirty-eight affected patients from 1974 to 1986 were reviewed. Patients with recurrent cancer responsible for symptoms were excluded. Seventy-one percent of patients presented with bowel obstruction. Twenty-one patients were treated with bowel resection, while 17 were treated with a bypass procedure or diverting ostomy alone. Overall morbidity was 45%, and postoperative mortality was 16%. Patients in the bypass group were significantly older than those in the resection group (70.3 vs. 55.5 years, P = .024), suggesting that age may have been a determinant of the procedure performed. In our study there was no difference in outcome based on preexisting vascular disease, tumor site, type of procedure performed, or radiation dose. We conclude that resection is the procedure of choice in cases of chronic radiation enteritis requiring surgery except in cases with dense adhesions when enteroenterostomal bypass is a viable alternative.

Small bowel function after surgery for chronic radiation enteritis.

The retention of the gamma-emitting 75Se-homotaurocholic acid (SeHCAT) after 72 and 168 h was assessed in 10 patients after ileal resection for radiation injury (group I). 6 patients suffering from chronic postirradiation diarrhea (group II) and 6 patients in whom the ileum had been resected for other indications (group III) were also examined. The retention of SeHCAT was abnormally low (less than 50%) in all cases after 72 h and below 20% in 19 out of 21 cases after 168 h. The length of resected small bowel (groups I and III) was inversely related with SeHCAT retention after 72 h (r = 0.63; p = 0.015), but not after 168 h. There was no correlation between the diarrhea score and the extent of bowel resection, SeHCAT retention or xylose absorption. Hydrogen breath test with lactulose revealed a significantly shortened orocecal transit time in group I, compared to groups II and III. Xylose absorption was significantly reduced in patients with positive 5 g xylose-H2 breath test. In groups I and III, however, xylose absorption tended to improve with increasing time interval following resection (r = 0.79; p = 0.003). It is concluded that radiation injury in addition to small-bowel resection contributes significantly to malabsorption and diarrhea in patients after ileal resection for radiation sequelae. The chronic radiation damage seems to act mainly through impaired motility.

The radiological features of chronic radiation enteritis

The radiological findings, using a single-contrast barium infusion technique, are described in a series of 13 patients with chronic radiation enteritis. The signs include evidence of submucosal thickening, single or multiple stenoses, adhesions and sinus or fistula formation. A combination of these signs characterises the condition. This technique is particularly suited to the investigation of radiation enteritis because of its ability to distend maximally the small intestine. A cause, stenosis and/or adhesions, was demonstrated in the eight of the 13 patients presenting with intermittent small-intestinal obstruction. Three patients had diarrhoea as their predominant complaint and a fistula was demonstrated in two.

Small bowel double-contrast enema in stage III ovarian cancer.

The efficiency of small bowel double-contrast enema in the detection and localization of tumor- or therapy-induced lesions of the intestine was studied retrospectively in 43 patients with stage III ovarian carcinoma. The radiographic findings in 62 examinations were verified by operative and autopsy findings and by the clinical course. Postoperative changes in the small bowel were noted in 69% of the patients (63% moderate, 6% severe). Signs of acute radiation enteritis were found in 36% (all moderate). Signs of chronic radiation enteropathy were detected in 71% (53% moderate, 18% severe). Small bowel obstruction due to recurrent tumor was correctly identified in 9%. Nonobstructing peritoneal implants were detected in 27% of the patients. The small bowel double-contrast enema is accurate in localizing lesions resulting from adhesions, acute and chronic radiation enteritis, or obstructing tumor; it is less efficient in detecting nonobstructive peritoneal metastases. The major clinical value of this examination is its ability to differentiate "dysfunctional intestine," which is managed conservatively, from focal obstruction requiring surgery. The radiographic features of chronic radiation enteritis on double-contrast enema examination are discussed in detail.

Surgical aspects of radiation enteritis of the small bowel.

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

Radiation therapy for the aging patient.

Radiation therapy for the aging patient.

Chronic Radiation Enteritis Complicating Non-Hodgkinʼs Lymphoma

A case of radiation enteritis in a patient with non-Hodgkin's lymphoma is described. The patient's complaints suggested recurrence of her lymphoma and radiographic studies were nondiagnostic of radiation-induced enteritis, delaying diagnosis and appropriate therapy. An inadvertent error in radiotherapy technic and fibrous adhesions resulting from the staging laparotomy contributed to the radiation injury. Radiation enteritis is a rare complication of irradiation of abdominal lymphoma, but it must be considered by physicians who encounter a similar situation.