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Radiation Enteritis

Updated : November 17, 2022





Background

Radiation enteritis is caused by radiation damage to the small or large intestines. This syndrome has been described using several terminologies, such as radiation mucositis, radiation colitis, radiation enteropathy, and pelvic radiation illness.

An alternative term for the involvement of the rectum and sigmoid colon is radiation proctitis. Many malignancies are treated with radiotherapy. The chronic form typically appears three months to 30 years following therapy.

Epidemiology

Radiation enteritis is relatively prevalent; studies have shown that 90% of people who receive pelvic radiotherapy have a lasting change in bowel habits. Some evidence suggests that it is more common in people undergoing radiation therapy for gynecological and gastrointestinal cancers than in persons undergoing radiation therapy for urological tumors. Chronic radiation enteritis affects 5 to 55% of individuals after radiotherapy.

Anatomy

Pathophysiology

Radiation enteritis is believed to be caused by repeated damage to the intestinal mucosa induced by ionizing radiation and its complex healing mechanism. Reactive ions are produced when normal tissues are exposed to radiation, interacting with intracellular water molecules to generate radicals such as hydroxyl and other free radicals.

These radicals are responsible for cell death and DNA breakage. Radiation exposure causes the stimulation of genes responsible for the translation of transforming growth factors. This activation promotes fibrosis by stimulating collagen and fibronectin genes. Tissues that proliferate rapidly are vulnerable to radiation, so cell membrane rupture is also responsible for the observed cell death.

Small intestine epithelial cells are more radiosensitive than rectum and colon epithelial cells. According to research, the presence of Bcl2 in the rectum is the cause of this distinction. The most common pathologic alterations in the intestinal epithelium are obliterative endarteritis and fibrosis.

Etiology

Radiation enteritis is an unpreventable side effect of radiotherapy, but its severity varies greatly depending on the gut’s duration, dosage, and sensitivity to radiation. Radiation enteritis is usually only brief, with the inflammation decreasing a few weeks following treatment.

Radiation enteritis might last for months or years after radiation therapy is completed. Complications of chronic radiation enteritis include diarrhea, anemia, and intestinal blockage.

Genetics

Prognostic Factors

Radiation enteritis has been demonstrated to be affected by various circumstances, including the dose of radiation, previous abdominal surgery, BMI, hypertension, and diabetes, which are examples of comorbid conditions.

According to statistics, many patients who undergo surgery for radiotherapy-induced gut damage die from their original malignancy within two years. Without a return of cancer, the 5-year survival rate is over 70%.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK526032/

Radiation Enteritis

Updated : November 17, 2022




Radiation enteritis is caused by radiation damage to the small or large intestines. This syndrome has been described using several terminologies, such as radiation mucositis, radiation colitis, radiation enteropathy, and pelvic radiation illness.

An alternative term for the involvement of the rectum and sigmoid colon is radiation proctitis. Many malignancies are treated with radiotherapy. The chronic form typically appears three months to 30 years following therapy.

Radiation enteritis is relatively prevalent; studies have shown that 90% of people who receive pelvic radiotherapy have a lasting change in bowel habits. Some evidence suggests that it is more common in people undergoing radiation therapy for gynecological and gastrointestinal cancers than in persons undergoing radiation therapy for urological tumors. Chronic radiation enteritis affects 5 to 55% of individuals after radiotherapy.

Radiation enteritis is believed to be caused by repeated damage to the intestinal mucosa induced by ionizing radiation and its complex healing mechanism. Reactive ions are produced when normal tissues are exposed to radiation, interacting with intracellular water molecules to generate radicals such as hydroxyl and other free radicals.

These radicals are responsible for cell death and DNA breakage. Radiation exposure causes the stimulation of genes responsible for the translation of transforming growth factors. This activation promotes fibrosis by stimulating collagen and fibronectin genes. Tissues that proliferate rapidly are vulnerable to radiation, so cell membrane rupture is also responsible for the observed cell death.

Small intestine epithelial cells are more radiosensitive than rectum and colon epithelial cells. According to research, the presence of Bcl2 in the rectum is the cause of this distinction. The most common pathologic alterations in the intestinal epithelium are obliterative endarteritis and fibrosis.

Radiation enteritis is an unpreventable side effect of radiotherapy, but its severity varies greatly depending on the gut’s duration, dosage, and sensitivity to radiation. Radiation enteritis is usually only brief, with the inflammation decreasing a few weeks following treatment.

Radiation enteritis might last for months or years after radiation therapy is completed. Complications of chronic radiation enteritis include diarrhea, anemia, and intestinal blockage.

Radiation enteritis has been demonstrated to be affected by various circumstances, including the dose of radiation, previous abdominal surgery, BMI, hypertension, and diabetes, which are examples of comorbid conditions.

According to statistics, many patients who undergo surgery for radiotherapy-induced gut damage die from their original malignancy within two years. Without a return of cancer, the 5-year survival rate is over 70%.

https://www.ncbi.nlm.nih.gov/books/NBK526032/