Materiały źródłowe

• #1 Diagnosis and management of chronic radiation enteritis – UpToDate

  https://www.uptodate.com/contents/diagnosis-and-management-of-chronic-radiation-enteritis/print

  Diagnosis and management of chronic radiation enteritis […] 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. […] 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.

• #2 Health Information Library | Rumah Sakit Pusat Pertamina

  https://rspp.co.id/dcontent.html?id=CON-20248518&n=Radiation%20enteritis

  Diagnosis for radiation enteritis might start with a discussion of your medical history and a physical exam. […] To see inside your small intestine, a long flexible tube with a camera is passed down your throat (endoscopy). Or the tube can be passed through your rectum to look at your large intestine (colonoscopy). Sometimes a pill-sized camera that you swallow is used to create pictures of your intestines (capsule endoscopy). Other tests might include imaging tests, such as X-rays, a CT scan or an MRI scan.

• #2 Enteritis and cancer | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/enteritis-and-cancer

  Radiation enteritis is a specific type of enteritis that occurs as a result of radiation therapy during cancer treatment. […] The likelihood of developing radiation enteritis depends on multiple factors, including where the radiation was targeted, strength and frequency of radiation treatment, tumor size, amount of bowel exposed to radiation, whether radiation therapy was given at the same time as chemotherapy, presence of radioactive implants to target tumors, and patient health and nutritional status. […] For acute radiation enteritis, diagnosis is made based on symptoms appearing shortly after radiation therapy has begun. Symptoms may take between nine and fourteen months to appear. For chronic radiation enteritis, the observation of symptoms and a patient history are used to make a diagnosis. […] In the mid-2020s, new treatments emerged for acute and chronic enteritis, including probiotics and fecal transplant.

• #3 Radiation Enteritis: Symptoms, Diagnosis and Treatments

  https://www.healthline.com/health/radiation-enteritis

  How Is Radiation Enteritis Diagnosed? […] Your doctor will mainly ask you questions about your bowel movements if they suspect that you have enteritis. They will want to know when your diarrhea started, how long it lasted, what the diarrhea looks like, whether there was any blood in the stool, and how often you have to use the bathroom. Your doctor will also ask about your current diet and medications you are taking. […] In addition to a physical exam, some of the following diagnostic tests may be recommended: […] endoscopy: a lighted tube is inserted into the mouth so doctors can view the upper part of the small intestine […] colonoscopy: a lighted tube is entered into the colon, so doctors can get a view of the lower part of the small intestine […] capsule endoscopy: you will swallow a small pill that contains a camera, which allows the doctor to view sections of the small intestine that other methods cannot see […] Other imaging tests, such as an abdominal CT scan or a set of x-rays of the abdomen known as an upper gastrointestinal series.

• #4 Radiation Enteritis and Proctocolitis – Clinical Tree

  https://clinicalpub.com/radiation-enteritis-and-proctocolitis/

  Symptoms of radiation enteritis are nonspecific, and the differential diagnosis is broad. The timing of the symptoms suggests the diagnosis. Acute enteritis is generally an abrupt illness with nausea, vomiting, diarrhea, and bleeding. Chronic enteritis is more gradual onset of initially vague abdominal pain or discomfort, constipation, and nausea. Patients with acute enteritis usually have tenderness upon abdominal palpation as a result of the active inflammation, whereas persons with chronic enteritis usually do not have tenderness. […] Laboratory testing, including tumor markers to rule out recurrence or a secondary malignancy, should be performed. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) and upper or lower endoscopy are useful imaging procedures to make the diagnosis and establish the location and extent of the disease. Enteroscopy or capsule endoscopy also may be helpful, but in patients with chronic enteritis, strictures may exclude their use. Biopsies are usually nonspecific but can rule out other causes of inflammation. Biopsies of chronic radiation enteritis often show evidence of ischemia because of the stenosing vasculitis that is a feature of the disease.

• #5 Radiation Enteritis and Proctitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/197483-workup

  In patients with acute radiation-induced intestinal injury, the complete blood count (CBC) and differential count may be within the reference range. With chronic injury, anemia may be noted because of chronic blood loss and malnutrition. Elevated white blood cell (WBC) counts are observed with small-bowel obstruction and intra-abdominal sepsis due to bowel perforation or necrosis. […] Complete metabolic panel results reveal electrolyte abnormalities. […] Patients with chronic malnutrition because of malabsorption have abnormal liver function test results and coagulation profiles. […] In the presence of mild intestinal injury, findings from plain abdominal radiography are nonspecific. Dilated bowel loops with air-fluid levels indicate bowel obstruction. Free air indicates perforation in severe acute or chronic enteropathy, especially in the presence of associated bowel obstruction.

• #6 Radiation Enteritis and Proctitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/197483-workup

  In patients with acute radiation-induced intestinal injury, the complete blood count (CBC) and differential count may be within the reference range. With chronic injury, anemia may be noted because of chronic blood loss and malnutrition. Elevated white blood cell (WBC) counts are observed with small-bowel obstruction and intra-abdominal sepsis due to bowel perforation or necrosis. […] Complete metabolic panel results reveal electrolyte abnormalities. […] Patients with chronic malnutrition because of malabsorption have abnormal liver function test results and coagulation profiles. […] In the presence of mild intestinal injury, findings from plain abdominal radiography are nonspecific. Dilated bowel loops with air-fluid levels indicate bowel obstruction. Free air indicates perforation in severe acute or chronic enteropathy, especially in the presence of associated bowel obstruction.

• #7 Radiation Enteritis and Proctocolitis – Clinical Tree

  https://clinicalpub.com/radiation-enteritis-and-proctocolitis/

  Symptoms of radiation enteritis are nonspecific, and the differential diagnosis is broad. The timing of the symptoms suggests the diagnosis. Acute enteritis is generally an abrupt illness with nausea, vomiting, diarrhea, and bleeding. Chronic enteritis is more gradual onset of initially vague abdominal pain or discomfort, constipation, and nausea. Patients with acute enteritis usually have tenderness upon abdominal palpation as a result of the active inflammation, whereas persons with chronic enteritis usually do not have tenderness. […] Laboratory testing, including tumor markers to rule out recurrence or a secondary malignancy, should be performed. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) and upper or lower endoscopy are useful imaging procedures to make the diagnosis and establish the location and extent of the disease. Enteroscopy or capsule endoscopy also may be helpful, but in patients with chronic enteritis, strictures may exclude their use. Biopsies are usually nonspecific but can rule out other causes of inflammation. Biopsies of chronic radiation enteritis often show evidence of ischemia because of the stenosing vasculitis that is a feature of the disease.

• #8 Radiation enteritis – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/radiation-enteritis/care-at-mayo-clinic/mac-20355412

  Mayo Clinic specialists review your medical history and perform a physical exam to better understand your condition. […] Additional tests and procedures may be used to understand the extent of your radiation enteritis, including: […] Endoscopy allows examination of your stomach and the beginning of your small intestine. […] Colonoscopy can uncover changes in the colon and areas of inflammation. […] A capsule endoscopy allows for the inspection of the small intestine, which is difficult to access with other tests, such as endoscopy and colonoscopy. […] During enteroscopy, a camera-equipped scope reaches deeper into your small intestine to look for signs of radiation enteritis. […] These imaging tests may show changes in your small intestine that suggest radiation enteritis. […] Mayo Clinic experts have extensive experience diagnosing and treating radiation enteritis. […] Each year, nearly 100 people with radiation enteritis receive care at Mayo Clinic.

• #9 Radiation enteritis – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/radiation-enteritis/care-at-mayo-clinic/mac-20355412

  Mayo Clinic specialists review your medical history and perform a physical exam to better understand your condition. […] Additional tests and procedures may be used to understand the extent of your radiation enteritis, including: […] Endoscopy allows examination of your stomach and the beginning of your small intestine. […] Colonoscopy can uncover changes in the colon and areas of inflammation. […] A capsule endoscopy allows for the inspection of the small intestine, which is difficult to access with other tests, such as endoscopy and colonoscopy. […] During enteroscopy, a camera-equipped scope reaches deeper into your small intestine to look for signs of radiation enteritis. […] These imaging tests may show changes in your small intestine that suggest radiation enteritis. […] Mayo Clinic experts have extensive experience diagnosing and treating radiation enteritis. […] Each year, nearly 100 people with radiation enteritis receive care at Mayo Clinic.

• #10 radiation enteritis

  https://www.aboutcancer.com/radiation_enteritis_utd_807.htm

  Enteroclysis involves the instillation of contrast material (usually administered through a nasoenteric tube) into the small bowel using a pump. […] CT may be helpful in narrowing the differential diagnosis, particularly in distinguishing strictures due to radiation enteritis from those arising from abdominal metastases or a local recurrence. […] Colonoscopy is helpful in evaluating colonic involvement and can also visualize the terminal ileum. […] Mucosal features consistent with radiation injury include pallor with friability and telangiectasias, which can be multiple, large, and serpiginous; these changes tend to be continuous. […] The differential diagnosis of chronic radiation enteritis is broad. […] Management should be conservative, addressing the predominant symptoms. […] Patients with diarrhea, abdominal pain, nausea or bloating should undergo breath testing for bacterial overgrowth and treated with antibiotics if bacterial overgrowth is confirmed. […] Despite conservative measures, surgery will be required in approximately 30 percent of patients. […] Prognosis is variable since the disease is progressive.

• #11 Radiation Enteritis and Proctitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/197483-workup

  Because most patients have undergone prior surgery, computed tomography (CT) of the abdomen and pelvis is the best study for revealing bowel obstruction. CT may differentiate a partial obstruction from a complete obstruction, as well as define the site of obstruction. Additionally, recurrent malignancy may often be identified. Most patients with obstructive symptoms because of radiation injury present with recurrent partial obstructions. Patients who present with complete bowel obstructions require surgical exploration and definitive treatment based on the pathology encountered. […] Endoscopy is generally avoided in the acute phases of radiation enteritis because of the risk of perforation. Colonoscopy may be necessary to establish a diagnosis or to treat hemorrhage. In these instances, endoscopy is performed cautiously, with minimal bowel insufflation. The intestinal and rectal mucosa is friable and edematous, with areas of superficial ulceration. In severe acute radiation injury, the mucosa may be intensely inflamed, with diffuse duskiness, edema, and extensive ulcerations.

• #12 Health Information Library | Rumah Sakit Pusat Pertamina

  https://rspp.co.id/dcontent.html?id=CON-20248518&n=Radiation%20enteritis

  Diagnosis for radiation enteritis might start with a discussion of your medical history and a physical exam. […] To see inside your small intestine, a long flexible tube with a camera is passed down your throat (endoscopy). Or the tube can be passed through your rectum to look at your large intestine (colonoscopy). Sometimes a pill-sized camera that you swallow is used to create pictures of your intestines (capsule endoscopy). Other tests might include imaging tests, such as X-rays, a CT scan or an MRI scan.

• #13 Radiation Enteritis and Proctitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/197483-workup

  In patients with acute radiation-induced intestinal injury, the complete blood count (CBC) and differential count may be within the reference range. With chronic injury, anemia may be noted because of chronic blood loss and malnutrition. Elevated white blood cell (WBC) counts are observed with small-bowel obstruction and intra-abdominal sepsis due to bowel perforation or necrosis. […] Complete metabolic panel results reveal electrolyte abnormalities. […] Patients with chronic malnutrition because of malabsorption have abnormal liver function test results and coagulation profiles. […] In the presence of mild intestinal injury, findings from plain abdominal radiography are nonspecific. Dilated bowel loops with air-fluid levels indicate bowel obstruction. Free air indicates perforation in severe acute or chronic enteropathy, especially in the presence of associated bowel obstruction.

• #14 Radiation Enteritis and Proctitis Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/197483-workup

  Because most patients have undergone prior surgery, computed tomography (CT) of the abdomen and pelvis is the best study for revealing bowel obstruction. CT may differentiate a partial obstruction from a complete obstruction, as well as define the site of obstruction. Additionally, recurrent malignancy may often be identified. Most patients with obstructive symptoms because of radiation injury present with recurrent partial obstructions. Patients who present with complete bowel obstructions require surgical exploration and definitive treatment based on the pathology encountered. […] Endoscopy is generally avoided in the acute phases of radiation enteritis because of the risk of perforation. Colonoscopy may be necessary to establish a diagnosis or to treat hemorrhage. In these instances, endoscopy is performed cautiously, with minimal bowel insufflation. The intestinal and rectal mucosa is friable and edematous, with areas of superficial ulceration. In severe acute radiation injury, the mucosa may be intensely inflamed, with diffuse duskiness, edema, and extensive ulcerations.

• #15 Radiation-induced enteritis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/radiation-induced-enteritis-1?lang=us/1000

  Radiation-induced enteritis is a small bowel pathology resulting from toxic effects of radiotherapy on the small bowel wall and vasculature. […] The clinical presentation is non-specific with abdominal pain, vomiting, bloody diarrhea and steatorrhea. Patients with chronic radiation enteritis may develop deficiencies of calcium, iron and vitamin B12 deficiency. […] Following pelvic radiotherapy, enteritis of the small bowel typically involves the more fixed terminal ileum and manifests as bowel wall thickening and submucosal edema at CT. […] Radiation-induced enteritis resulting in small bowel obstruction. […] Small bowel oedema after rectal cancer radiotherapy.

• #16 Radiation Enteritis – StatPearls – NCBI Bookshelf

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

  Radiation enteritis is damage to the small and/or large intestines secondary to radiation. Different terms like radiation colitis, radiation enteropathy, radiation mucositis, and pelvic radiation disease have been used to describe this phenomenon. Radiation enteritis can be acute or chronic. The chronic form usually develops between 3 months to 30 years after treatment. This activity reviews the evaluation and management of radiation enteritis and highlights the role of the interprofessional team in caring for affected patients. […] Patients with diarrhea, abdominal pain, or bloating should also undergo breath testing for bacterial overgrowth. […] CT and MRI are used to see pathological changes not observed on conventional imaging. […] Many scoring systems exist to assess the severity of symptoms in patients undergoing radiotherapy but none succeeded in fulfilling the purpose.

• #17 radiation enteritis

  https://www.aboutcancer.com/radiation_enteritis_utd_807.htm

  Enteroclysis involves the instillation of contrast material (usually administered through a nasoenteric tube) into the small bowel using a pump. […] CT may be helpful in narrowing the differential diagnosis, particularly in distinguishing strictures due to radiation enteritis from those arising from abdominal metastases or a local recurrence. […] Colonoscopy is helpful in evaluating colonic involvement and can also visualize the terminal ileum. […] Mucosal features consistent with radiation injury include pallor with friability and telangiectasias, which can be multiple, large, and serpiginous; these changes tend to be continuous. […] The differential diagnosis of chronic radiation enteritis is broad. […] Management should be conservative, addressing the predominant symptoms. […] Patients with diarrhea, abdominal pain, nausea or bloating should undergo breath testing for bacterial overgrowth and treated with antibiotics if bacterial overgrowth is confirmed. […] Despite conservative measures, surgery will be required in approximately 30 percent of patients. […] Prognosis is variable since the disease is progressive.

• #18 radiation enteritis

  https://www.aboutcancer.com/radiation_enteritis_utd_807.htm

  Enteroclysis involves the instillation of contrast material (usually administered through a nasoenteric tube) into the small bowel using a pump. […] CT may be helpful in narrowing the differential diagnosis, particularly in distinguishing strictures due to radiation enteritis from those arising from abdominal metastases or a local recurrence. […] Colonoscopy is helpful in evaluating colonic involvement and can also visualize the terminal ileum. […] Mucosal features consistent with radiation injury include pallor with friability and telangiectasias, which can be multiple, large, and serpiginous; these changes tend to be continuous. […] The differential diagnosis of chronic radiation enteritis is broad. […] Management should be conservative, addressing the predominant symptoms. […] Patients with diarrhea, abdominal pain, nausea or bloating should undergo breath testing for bacterial overgrowth and treated with antibiotics if bacterial overgrowth is confirmed. […] Despite conservative measures, surgery will be required in approximately 30 percent of patients. […] Prognosis is variable since the disease is progressive.

• #19 Acute and Chronic Radiation Enteropathy | Radiology Key

  https://radiologykey.com/acute-and-chronic-radiation-enteropathy/

  Radiographic abnormalities detected on small bowel series and CT typically include thickening of the small bowel folds and the intestinal wall with or without intramural hemorrhage, edema, and mucosal ulceration. […] Magnetic resonance (MR) enterography for the evaluation of Crohns disease is well described in literature, and has an evolving role in the evaluation of other small-bowel diseases including radiation enteritis. […] Capsule endoscopy can be used to diagnose radiation enteropathy, but is generally avoided given the risk of the capsule becoming trapped in a strictured segment requiring surgical removal. […] Mucosal biopsies are usually not diagnostic, but can eliminate other causes of small bowel injury including inflammatory bowel disease, infections, and nonsteroidal anti-inflammatory drug (NSAID)-induced damage.

• #20 How do you manage/treat acute radiation-induced enteritis?

  https://www.themednet.org/how-do-you-manage-treat-acute-radiation-induced-enteritis

  First – one needs to be sure that the patient truly has radiation enteritis. […] The management for acute radiation-induced enteritis is symptomatic in nature, with the best long-term solution being a tincture of time from the completion of radiation. […] Oftentimes, radiation enteritis is the result of small intestinal bacterial overgrowth (SIBO), a phenomenon described (and demonstrated with lactulose hydrogen breath testing) in numerous abdominal and pelvic radiotherapy patients. […] Simple measures including low residue/stimulus diet are often recommended.

• #21 Radiation Enteritis – StatPearls – NCBI Bookshelf

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

  Radiation enteritis is damage to the small and/or large intestines secondary to radiation. Different terms like radiation colitis, radiation enteropathy, radiation mucositis, and pelvic radiation disease have been used to describe this phenomenon. Radiation enteritis can be acute or chronic. The chronic form usually develops between 3 months to 30 years after treatment. This activity reviews the evaluation and management of radiation enteritis and highlights the role of the interprofessional team in caring for affected patients. […] Patients with diarrhea, abdominal pain, or bloating should also undergo breath testing for bacterial overgrowth. […] CT and MRI are used to see pathological changes not observed on conventional imaging. […] Many scoring systems exist to assess the severity of symptoms in patients undergoing radiotherapy but none succeeded in fulfilling the purpose.

• #22 Gastrointestinal Complications (PDQ®) – NCI

  https://www.cancer.gov/about-cancer/treatment/side-effects/constipation/gi-complications-hp-pdq

  Medical management includes treating diarrhea, dehydration, malabsorption, and abdominal or rectal discomfort. Symptoms usually resolve with medications, dietary changes, and rest. […] Damage to the intestinal villi from radiation therapy results in a reduction or loss of enzymes, such as lactase. […] Only 10% to 20% of patients who receive abdominal or pelvic irradiation develop chronic radiation enteritis. Signs and symptoms include colicky abdominal pain, bloody diarrhea, steatorrhea, weight loss, nausea and vomiting. […] The diagnosis of chronic radiation enteritis may be difficult to make. Clinically and radiologically recurrent tumor needs to be ruled out.

• #23 Multi‑slice spiral CT evaluation of chronic radiation colitis and rectitis

  https://www.spandidos-publications.com/10.3892/etm.2020.9069

  The CT findings were retrospectively reviewed by the consensus of two experienced radiologists. […] The thickness of the bladder wall was increased evenly (n=5, 21.7%); patients with urocystitis (n=2) were diagnosed using a cystoscope. […] The appearance of CRE on imaging lacks specificity and it must be clinically distinguished from intestinal tumours, inflammatory bowel disease and ischemic bowel disease. […] In summary, the CT manifestations of CRCR are variable and non-specific but are easily diagnosed when combined with a history of radiotherapy and clinical manifestations.

• #24 Acute and Chronic Radiation Enteropathy | Radiology Key

  https://radiologykey.com/acute-and-chronic-radiation-enteropathy/

  Radiographic abnormalities detected on small bowel series and CT typically include thickening of the small bowel folds and the intestinal wall with or without intramural hemorrhage, edema, and mucosal ulceration. […] Magnetic resonance (MR) enterography for the evaluation of Crohns disease is well described in literature, and has an evolving role in the evaluation of other small-bowel diseases including radiation enteritis. […] Capsule endoscopy can be used to diagnose radiation enteropathy, but is generally avoided given the risk of the capsule becoming trapped in a strictured segment requiring surgical removal. […] Mucosal biopsies are usually not diagnostic, but can eliminate other causes of small bowel injury including inflammatory bowel disease, infections, and nonsteroidal anti-inflammatory drug (NSAID)-induced damage.

• #25 Radiation Enteritis and Proctocolitis – Clinical Tree

  https://clinicalpub.com/radiation-enteritis-and-proctocolitis/

  Symptoms of radiation enteritis are nonspecific, and the differential diagnosis is broad. The timing of the symptoms suggests the diagnosis. Acute enteritis is generally an abrupt illness with nausea, vomiting, diarrhea, and bleeding. Chronic enteritis is more gradual onset of initially vague abdominal pain or discomfort, constipation, and nausea. Patients with acute enteritis usually have tenderness upon abdominal palpation as a result of the active inflammation, whereas persons with chronic enteritis usually do not have tenderness. […] Laboratory testing, including tumor markers to rule out recurrence or a secondary malignancy, should be performed. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) and upper or lower endoscopy are useful imaging procedures to make the diagnosis and establish the location and extent of the disease. Enteroscopy or capsule endoscopy also may be helpful, but in patients with chronic enteritis, strictures may exclude their use. Biopsies are usually nonspecific but can rule out other causes of inflammation. Biopsies of chronic radiation enteritis often show evidence of ischemia because of the stenosing vasculitis that is a feature of the disease.

• #26 Radiation Enteritis – StatPearls – NCBI Bookshelf

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

  Radiation enteritis is damage to the small and/or large intestines secondary to radiation. Different terms like radiation colitis, radiation enteropathy, radiation mucositis, and pelvic radiation disease have been used to describe this phenomenon. Radiation enteritis can be acute or chronic. The chronic form usually develops between 3 months to 30 years after treatment. This activity reviews the evaluation and management of radiation enteritis and highlights the role of the interprofessional team in caring for affected patients. […] Patients with diarrhea, abdominal pain, or bloating should also undergo breath testing for bacterial overgrowth. […] CT and MRI are used to see pathological changes not observed on conventional imaging. […] Many scoring systems exist to assess the severity of symptoms in patients undergoing radiotherapy but none succeeded in fulfilling the purpose.

• #27 Radiation Enteritis – MD Searchlight

  https://mdsearchlight.com/gut-health/radiation-enteritis/

  Radiation enteritis is a condition where the small and/or large intestines get damaged due to radiation exposure. […] Radiation enteritis is a common but unpredictable side effect of radiation therapy. […] Radiation enteritis is fairly widespread, resulting in lasting changes in bowel habits for around 90% of people who undergo pelvic radiotherapy. […] If you have symptoms like diarrhea, stomach pain, or a feeling of fullness, your doctor may recommend a breath test. […] Your doctor may also recommend a CT scan or MRI. […] There are various scoring systems to rate the severity of symptoms for patients undergoing radiation treatment. However, none of these have been successful in achieving this goal. […] After radiation therapy, doctors should actively monitor for any signs that the cancer might have come back.

• #28 Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

  https://www.wjgnet.com/1007-9327/full/v29/i8/1344.htm

  The diagnosis and classification of RE were determined following the National Institutes of Health Common Adverse Events Evaluation Criteria (CTCAE 5.0). We established the SARE-SS to reflect the adverse reaction score as follows: SARE-SS = the sum of CTCAE scores of diarrhea + abdominal pain + colitis + anal bulging + hematochezia. A score of 3 indicated the presence of SARE. The diagnosis of SARE was determined by at least two experienced radiation oncologists on the basis of clinical symptoms and changes in the results of ancillary tests. […] In univariate analysis, abdominal pain, colitis, anal distension, hematochezia, DAI score, age, and CCRT were statistically correlated with the occurrence of severe acute RE (P < 0.05). [...] The multi-factor prediction model is helpful to further improve the prediction of RE. Several prediction models have been described in previous studies, but they are still not used in clinic due to the low recognition ability of RE and the neglect of heterogeneity among different patients. In this study, we established a SARE-SS evaluation system and found that anal bulge rating and DAI score were independent predictors of SARE through multivariate statistical analysis. The above predictors were further integrated into the nomogram to allow precise individualized SARE risk assessment for each patient. The AUC of the predictive model was 0.950, which was much higher than the two independent factors of DAI score and anal bulge score.

• #29 Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

  https://www.wjgnet.com/1007-9327/full/v29/i8/1344.htm

  The diagnosis and classification of RE were determined following the National Institutes of Health Common Adverse Events Evaluation Criteria (CTCAE 5.0). We established the SARE-SS to reflect the adverse reaction score as follows: SARE-SS = the sum of CTCAE scores of diarrhea + abdominal pain + colitis + anal bulging + hematochezia. A score of 3 indicated the presence of SARE. The diagnosis of SARE was determined by at least two experienced radiation oncologists on the basis of clinical symptoms and changes in the results of ancillary tests. […] In univariate analysis, abdominal pain, colitis, anal distension, hematochezia, DAI score, age, and CCRT were statistically correlated with the occurrence of severe acute RE (P < 0.05). [...] The multi-factor prediction model is helpful to further improve the prediction of RE. Several prediction models have been described in previous studies, but they are still not used in clinic due to the low recognition ability of RE and the neglect of heterogeneity among different patients. In this study, we established a SARE-SS evaluation system and found that anal bulge rating and DAI score were independent predictors of SARE through multivariate statistical analysis. The above predictors were further integrated into the nomogram to allow precise individualized SARE risk assessment for each patient. The AUC of the predictive model was 0.950, which was much higher than the two independent factors of DAI score and anal bulge score.

• #30 Diagnosis and management of chronic radiation enteritis – UpToDate

  https://www.uptodate.com/contents/diagnosis-and-management-of-chronic-radiation-enteritis/print

  Diagnosis and management of chronic radiation enteritis […] 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. […] 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.

• #31 radiation enteritis

  https://www.aboutcancer.com/radiation_enteritis_utd_807.htm

  The diagnosis is usually established by suggestive radiologic findings in patients with compatible clinical features who have a history of prior radiation exposure. […] The patient’s previous radiation treatment record should be reviewed to determine the total dose and distribution of the radiation field. […] We usually obtain an abdominal CT scan followed by an upper gastrointestinal series with small bowel follow through in patients with suspected small bowel disease. […] Additional imaging is reserved for patients in whom the diagnosis remains unclear. […] We generally perform a colonoscopy in patients with suspected colonic involvement. […] An upper gastrointestinal series with small bowel follow-through is a useful initial test for evaluating the extent of disease although it is not as sensitive as enteroclysis.

• #32 Enteritis and cancer | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/enteritis-and-cancer

  Radiation enteritis is a specific type of enteritis that occurs as a result of radiation therapy during cancer treatment. […] The likelihood of developing radiation enteritis depends on multiple factors, including where the radiation was targeted, strength and frequency of radiation treatment, tumor size, amount of bowel exposed to radiation, whether radiation therapy was given at the same time as chemotherapy, presence of radioactive implants to target tumors, and patient health and nutritional status. […] For acute radiation enteritis, diagnosis is made based on symptoms appearing shortly after radiation therapy has begun. Symptoms may take between nine and fourteen months to appear. For chronic radiation enteritis, the observation of symptoms and a patient history are used to make a diagnosis. […] In the mid-2020s, new treatments emerged for acute and chronic enteritis, including probiotics and fecal transplant.

• #33 Diagnosis and management of chronic radiation enteritis – UpToDate

  https://www.uptodate.com/contents/diagnosis-and-management-of-chronic-radiation-enteritis/print

  Diagnosis and management of chronic radiation enteritis […] 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. […] 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.

• #34 Acute Ileal Perforation Caused by Radiation Enteritis After Restoration

  https://coloproctol.org/DOIx.php?id=10.3393/ac.2020.07.30

  Few radiation-induced bowel perforations have been reported to date. […] Herein, we report a rare complication of radiation enteritis, namely ileal perforation, after ileal restoration in a patient who underwent preoperative CRT. […] CT images suggested peritonitis associated with bowel perforation, including free air, ascites, peritoneal infiltration, and thickening with enhancement. […] Considering the CT findings and the nature of the drainage fluid, emergency surgery was planned. […] Postoperative histology revealed the perforation site with a transmural tissue defect and acute fibrinous inflammation. […] Taken together, these pathologic features are consistent with perforated severe radiation enteritis. […] Diagnosis should be based on a combination of the patients clinical symptoms, history, laboratory result, imaging finding, and physical examination.

• #35 Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

  https://www.wjgnet.com/1007-9327/full/v29/i8/1344.htm

  The diagnosis and classification of RE were determined following the National Institutes of Health Common Adverse Events Evaluation Criteria (CTCAE 5.0). We established the SARE-SS to reflect the adverse reaction score as follows: SARE-SS = the sum of CTCAE scores of diarrhea + abdominal pain + colitis + anal bulging + hematochezia. A score of 3 indicated the presence of SARE. The diagnosis of SARE was determined by at least two experienced radiation oncologists on the basis of clinical symptoms and changes in the results of ancillary tests. […] In univariate analysis, abdominal pain, colitis, anal distension, hematochezia, DAI score, age, and CCRT were statistically correlated with the occurrence of severe acute RE (P < 0.05). [...] The multi-factor prediction model is helpful to further improve the prediction of RE. Several prediction models have been described in previous studies, but they are still not used in clinic due to the low recognition ability of RE and the neglect of heterogeneity among different patients. In this study, we established a SARE-SS evaluation system and found that anal bulge rating and DAI score were independent predictors of SARE through multivariate statistical analysis. The above predictors were further integrated into the nomogram to allow precise individualized SARE risk assessment for each patient. The AUC of the predictive model was 0.950, which was much higher than the two independent factors of DAI score and anal bulge score.

• #36 The Hidden Link: Chronic Radiation Enteritis and Bile Acid Malabsorption in Cancer Survivors – Shreddies Australia & New Zealand

  https://shreddies.com.au/the-hidden-link/?srsltid=AfmBOopeZxG8XaODfZozWAoUToodXSIzeHvK8phXWoXYEUJz8OUlI2-M

  Chronic radiation enteritis is a long-term consequence of radiation therapy, characterized by inflammation and damage to the intestines. This condition can manifest months or even years after treatment, causing symptoms such as abdominal pain, diarrhea, and malabsorption of nutrients. […] Diagnostic tests, including stool tests, blood tests, imaging studies, and endoscopic evaluations, play a crucial role in identifying chronic radiation enteritis and bile acid malabsorption. However, it is important to note that specialized tests such as the SeHCAT scan, used to measure bile acid absorption, may not be widely accessible, causing further complications in diagnosis. […] Misdiagnosis can have significant consequences, as it may lead to delayed or ineffective treatment. Misidentifying chronic radiation enteritis or bile acid malabsorption as other gastrointestinal conditions, such as irritable bowel syndrome (IBS), can prolong suffering and impact the quality of life for cancer survivors. Accurate diagnosis is crucial for implementing targeted management strategies and ensuring timely treatment interventions.

• #37 Quality evaluation of guidelines for the diagnosis and treatment of radiation enteritis | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/s13014-023-02204-9

  To systematically evaluate the guidelines for the diagnosis and treatment of radioactive enteritis, compare their differences and reasons and provide some reference for updating them. […] Six diagnostic and therapeutic guidelines for radiation enteritis were included in this study, one of which, the American Society for Gastrointestinal Endoscopy guidelines, had an overall score of over 60%, which is worthy of clinical recommendation. […] The methodological quality of radioactive enteritis guidelines is unequal; even in the same guidelines, different domains have a large difference. […] This article reviews the diagnosis and treatment guidelines for radiation enteritis in order to promote further update of the guidelines. […] The treatment methods mentioned in different radiation enteritis guidelines vary widely.

• #38 Quality evaluation of guidelines for the diagnosis and treatment of radiation enteritis | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/s13014-023-02204-9

  To systematically evaluate the guidelines for the diagnosis and treatment of radioactive enteritis, compare their differences and reasons and provide some reference for updating them. […] Six diagnostic and therapeutic guidelines for radiation enteritis were included in this study, one of which, the American Society for Gastrointestinal Endoscopy guidelines, had an overall score of over 60%, which is worthy of clinical recommendation. […] The methodological quality of radioactive enteritis guidelines is unequal; even in the same guidelines, different domains have a large difference. […] This article reviews the diagnosis and treatment guidelines for radiation enteritis in order to promote further update of the guidelines. […] The treatment methods mentioned in different radiation enteritis guidelines vary widely.

• #39

  https://journals.lww.com/co-gastroenterology/fulltext/2020/05000/radiation_enteritis__from_diagnosis_to_management.11.aspx

  Radiation enteritis is a heterogenous condition with significant morbidity. […] The present review aims to provide a broad overview of the condition with particular attention to the diagnosis and management of the condition. […] Diagnosis and treatment are best approached in a systematic fashion with particular attention to the exclusion of recurrent malignancy and other gastrointestinal conditions. […] Clinical guidelines would allow standardised management which may improve the burden of the disease for patients.

• #40 Radiation enteropathy – Wikipedia

  https://en.wikipedia.org/wiki/Radiation_enteropathy

  Multiple disorders are found in patients with radiation enteropathy, so guidance including an algorithmic approach to their investigation has been developed. This includes a holistic assessment with investigations including upper endoscopy, colonoscopy, breath tests and other nutritional and gastrointestinal tests. Full investigation is important as many cancer survivors of radiation therapy develop other causes for their symptoms such as colonic polyps, diverticular disease or hemorrhoids. […] In people presenting with symptoms compatible with radiation enteropathy, the initial step is to identify what is responsible for causing the symptoms. Management is best with a multidisciplinary team including gastroenterologists, nurses, dietitians, surgeons and others.

• #41 Research progress and treatment of radiation enteritis and gut microbiota

  https://www.e-roj.org/journal/view.php?doi=10.3857/roj.2023.00346

  The basic pathological changes include two aspects: intestinal mucosal injury caused by radiation and vascular connective tissue injury caused by radiation vascular endothelial cells. […] Existing research results show that the gut microbiota of patients with radiation enteritis is significantly translocated, the number of Actinobacteriota and Proteobacteria is significantly increased, and many conditional pathogenic bacteria, such as Enterococcus and Enterobacterales, are included. […] In summary, the study mentioned above shows that the gut microbiota of the patients with radiation enteritis changes significantly in terms of composition and diversity. […] In recent years, many basic and clinical studies at home and abroad have been conducted on the relationship between gut microbiota and radioactive intestinal injury caused by pelvic radiotherapy, and considerable conclusions have been drawn.

• #42 Enteritis and cancer | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/enteritis-and-cancer

  Radiation enteritis is a specific type of enteritis that occurs as a result of radiation therapy during cancer treatment. […] The likelihood of developing radiation enteritis depends on multiple factors, including where the radiation was targeted, strength and frequency of radiation treatment, tumor size, amount of bowel exposed to radiation, whether radiation therapy was given at the same time as chemotherapy, presence of radioactive implants to target tumors, and patient health and nutritional status. […] For acute radiation enteritis, diagnosis is made based on symptoms appearing shortly after radiation therapy has begun. Symptoms may take between nine and fourteen months to appear. For chronic radiation enteritis, the observation of symptoms and a patient history are used to make a diagnosis. […] In the mid-2020s, new treatments emerged for acute and chronic enteritis, including probiotics and fecal transplant.

• #43 Research progress and treatment of radiation enteritis and gut microbiota

  https://www.e-roj.org/journal/view.php?doi=10.3857/roj.2023.00346

  Studies have confirmed that probiotics can be used in radiation enteritis, and the use of probiotic preparations such as Lactobacillus acidophilus, Bifidobacterium bifidum and Lactobacillus casei during pelvic radiotherapy resulted in a decrease in the average number of bowel movements and the incidence of diarrhea. […] Fecal microbiota transplantation (FMT) refers to the transplantation of feces from a healthy donor into the intestines of patients after isolation and culture in vitro to change the composition of their gut microbiota and further affect the digestive, metabolic and immune functions of patients. […] Studies have shown that FMT can relieve symptoms of radiation enteritis and improve gastrointestinal function.

• #44 Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

  https://www.wjgnet.com/1007-9327/full/v29/i8/1344.htm

  Cervical cancer is one of the most common gynecological malignant tumors. Radiation enteritis (RE) leads to radiotherapy intolerance or termination of radiotherapy, which negatively impacts the therapeutic effect and seriously affects the quality of life of patients. If the incidence of RE in patients can be predicted in advance, and targeted clinical preventive treatment can be carried out, the side effects of radiotherapy in cervical cancer patients can be significantly reduced. Furthermore, accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan. […] To analyze the relationships between severe acute RE (SARE) of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively. […] The aim of our study was to determine the cumulative incidence of acute RE associated with cervical cancer radiotherapy in patients with RE in organs at risk and changes in dose-volume histogram indices. The nomogram of severe acute RE (SARE) was further developed according to the clinical factors, cumulative incidence of SARE and dosimetric parameters of volumetric modulated arc therapy patients, which may be useful for individualized risk assessment and accurate prediction of SARE to guide clinical treatment strategies.

• #45

  https://journals.lww.com/co-gastroenterology/fulltext/2020/05000/radiation_enteritis__from_diagnosis_to_management.11.aspx

  Radiation enteritis is a heterogenous condition with significant morbidity. […] The present review aims to provide a broad overview of the condition with particular attention to the diagnosis and management of the condition. […] Diagnosis and treatment are best approached in a systematic fashion with particular attention to the exclusion of recurrent malignancy and other gastrointestinal conditions. […] Clinical guidelines would allow standardised management which may improve the burden of the disease for patients.

• #46 Radiation Enteritis – StatPearls – NCBI Bookshelf

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

  Patients who have enteritis leading to the formation of intestinal strictures, fistulas, and perforations require surgical procedures. […] It is important to resect the whole irradiated bowel in the first operation to reduce the need for more surgical procedures, but it is not a suitable option in every case due to fear of complications such as short bowel syndrome. […] The care of patients with radiation enteritis is interprofessional. […] When surgery is performed on the radiated intestine, this carries high morbidity and mortality. Complications that can result include non-healing of wounds, a breakdown of the intestinal anastomosis, pelvic abscess, secondary malignancy, and fistula formation.

• #47 Research progress and treatment of radiation enteritis and gut microbiota

  https://www.e-roj.org/journal/view.php?doi=10.3857/roj.2023.00346

  Radiation enteritis is a kind of intestinal radiation injury in patients with pelvic and retroperitoneal malignancies after radiotherapy, and its occurrence and development process are very complicated. At present, studies have confirmed that intestinal microecological imbalance is an important factor in the formation of this disease. Given the role of the microbiome in radiation enteritis, we suggest that the gut microbiota may be a potential biomarker for the disease. […] The mechanism of the gut microbiota in radiation enteritis has become a research hotspot. […] Radiation enteritis, which refers to radiation therapy-induced injury to the intestinal epithelium, with or without mild inflammation, is one of the common complications after radiation therapy in patients with pelvic malignancy.

• #48 Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

  https://www.wjgnet.com/1007-9327/full/v29/i8/1344.htm

  Cervical cancer is one of the most common gynecological malignant tumors. Radiation enteritis (RE) leads to radiotherapy intolerance or termination of radiotherapy, which negatively impacts the therapeutic effect and seriously affects the quality of life of patients. If the incidence of RE in patients can be predicted in advance, and targeted clinical preventive treatment can be carried out, the side effects of radiotherapy in cervical cancer patients can be significantly reduced. Furthermore, accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan. […] To analyze the relationships between severe acute RE (SARE) of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively. […] The aim of our study was to determine the cumulative incidence of acute RE associated with cervical cancer radiotherapy in patients with RE in organs at risk and changes in dose-volume histogram indices. The nomogram of severe acute RE (SARE) was further developed according to the clinical factors, cumulative incidence of SARE and dosimetric parameters of volumetric modulated arc therapy patients, which may be useful for individualized risk assessment and accurate prediction of SARE to guide clinical treatment strategies.

Zobacz więcej