OverviewChronic Radiation Enteritis
Section snippets
Statement of Search Strategies Used and Sources of Information
Relevant publications for review were identified using the PubMed database. Only English-language papers were reviewed using the following keywords alone or in combination: (chronic) radiation enteritis/ enteropathy AND investigation/ treatment/ management/ therapy/ (histo)pathology/ symptoms/ presentation/ prevention; (chronic) radiation enteritis/ enteropathy AND dietary management/ diet/ low residue/ gluten free/ elemental/ nutritional therapy; (chronic) radiation enteritis/ enteropathy AND
Pathogenesis
Radiation can cause injury by directly or indirectly targeting cellular DNA, which, in turn, leads to impaired cell division or immediate cell death [21]. The direct injurious effect of radiation results from the absorption of energy from incident radiation and usually occurs with high linear energy transfer radiation, such as protons and neutrons. The indirect effect of radiation is usually mediated by the release of free radicals that result from the interaction of radiation with cellular
Clinical Features and Diagnosis
The clinical features of chronic radiation enteritis are multiple, not least because the degree of injury to the gastrointestinal tract is influenced by a number of factors, as outlined above. Because radiation toxicity can affect separate parts of the gastrointestinal tract, the range of symptoms that patients can present with is vast, ranging from abdominal pain and vomiting to diarrhoea and flatulence [11]. Current symptom questionnaires, such as the LENT-SOMA (late effects normal tissue
Treatment
Despite the high prevalence of chronic radiation enteritis, the evidence base for treatment is limited (Table 4, Table 5). Nevertheless, there are a variety of potential therapeutic options available, which can be tailored to the clinical presentation and underlying aetiology.
Conclusion
The incidence of chronic radiation enteritis is increasing as more patients undergo pelvic radiotherapy for cancer treatment. Because symptom aetiology within any one patient is often multifactorial, it is important to adopt a structured approach when investigating gastrointestinal symptoms in patients who have received radiotherapy, as this should allow better targeting of the therapies that are available. However, because the evidence base for these therapies is currently limited, oncologists
Conflict of Interest
The authors declare that they have no proprietary, financial, professional or other personal interest that could be construed as influencing the data presented in this overview, but a note is made that Dr Lal has been a member of advisory boards for IBD medication and Dr Theis is married to an Astra Zeneca employee.
Acknowledgements
The authors would like to thank Dr Dominic Blunt, Consultant Radiologist, Hammersmith Hospital, London and Dr John Curtis, Consultant Radiologist, Aintree University Hospital, Liverpool for their help providing radiology images. We are also indebted to Dr Monica Terlizzo, Consultant Histopathologist, Aintree University Hospital, Liverpool for providing histopathology slides.
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2022, Seminars in Nuclear MedicineCitation Excerpt :Chronic radiation bowel disease due to progressive ischemia and transmural fibrosis can take years to develop. Progressive wall thickening and fixation of the bowel wall can result in strictures with subsequent obstruction that clinically and on imaging may mimic malignancy.174,175 The severity of complications is further influenced by factors that compromise the blood supply and mobility of the bowel wall, such as abdominal surgery, diverticular or pelvic inflammatory disease, and diabetes.176