Radiation enteritis

Digestive system — The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Also known as: Radiation enteropathy, Radiation-induced small bowel injury or Post-radiation enteritis

Definition

Radiation enteritis is damage to the lining of the intestines (bowels) due to radiation therapy, a type of cancer treatment.

Causes, incidence, and risk factors

Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells.

Along with the cancer cells, radiation therapy may also damage cells that make up the lining of the intestines.

Anyone who receives radiation therapy to the belly or pelvic area is at risk. This may include people with cervical, pancreatic, prostate, uterine, or colon and rectal cancer.

Symptoms

Symptoms may be different depending on what part of the intestines received the radiation.

Changes in bowel movements may include:

Bleeding or mucus from the rectum
Diarrhea or watery stools
Feeling the need to have a bowel movement most or all of the time
Pain in the rectal area, especially during bowel movements

Other symptoms can include:

Loss of appetite
Nausea and vomiting
Stomach cramping or pain

Most of the time, these symptoms get better within 2 - 3 weeks after radiation treatment ends. This is called acute radiation enteritis.

When symptoms become long-term (chronic), other problems may include:

Bloody diarrhea
Greasy or fatty stools
Weight loss

Signs and tests

The health care provider will do a physical exam and ask you questions about your medical history.

Tests are not needed very often, but may include:

Treatment

Starting a low-fiber diet on the first day of radiation treatment can be helpful.

Avoiding the following foods may help with symptoms:

Alcohol and tobacco
Almost all milk products
Coffee, tea, chocolate, and soda drinks with caffeine
Foods containing whole bran
Fresh and dried fruits
Fried, greasy, or fatty foods
Nuts and seeds
Popcorn, potato chips, and pretzels
Raw vegetables
Rich pastries and baked goods
Some fruit juices
Strong spices

Foods and drinks that are better choices include:

Apple or grape juice
Applesauce, peeled apples, and bananas
Eggs, buttermilk, and yogurt
Fish, poultry, and meat that has been broiled or roasted
Mild, cooked vegetables such as asparagus tips, green or black beans, carrots, spinach, and squash
Potatoes that have been baked, boiled, or mashed
Processed cheeses, such as American cheese
Smooth peanut butter
White bread, macaroni, or noodles

Other ways to control the symptoms of radiation enteritis include:

Eat foods at room temperature
Eat small meals more often

Your doctor may suggest or prescribe certain medications:

Drugs that help decrease diarrhea, such as loperamide
Pain medications
Steroid foam that coats the lining of the rectum
Special enzymes to replace enzymes from the pancreas

Drink plenty of fluids (up to 12 8-ounce glasses) every day when you have diarrhea. Some people need fluids given through a vein (intravenous fluids).

Your health care provider may choose to stop or reduce the dosage of radiation for a short period of time.

There often are no good treatments for chronic radiation enteritis. Your doctor may discuss surgery to either remove or go around (bypass) a section of damaged intestine.

Expectations (prognosis)

When the abdomen receives radiation, there is always some nausea, vomiting, and diarrhea. In most cases, the symptoms get better 2 - 3 weeks after treatment ends.

However, when this condition develops, symptoms may last for a long period of time. Long-term (chronic) enteritis is rarely curable.

Complications

Bleeding and anemia
Dehydration
Malabsorption
Malnutrition
Weight loss

Calling your health care provider

Call your health care provider if you are undergoing radiation therapy or have had radiation in the past and are experiencing a lot of diarrhea or stomach pain and cramping.

Prevention

Newer treatment methods are used, when possible, to avoid or decrease the chance of radiation enteritis. These methods include:

Adjusting how much radiation is given during any one treatment session, so that lower amounts are delivered more evenly or higher amounts are delivered to specific areas
Having a full bladder during treatments
Placing special clips surgically around the area needing radiation. This helps the radiation doctor focus on the treatment area.

References

Czito BG, Willett CG. Radiation injury. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010: chap 39.

Gastrointestinal Complications (PDQ). . Last modified October 8, 2009.

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Review date:: July 22, 2010
Reviewed by:: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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