Radiation Enteritis

Causes and Symptoms

Radiation therapy stops the growth of rapidly dividing cells, such as cancer cells. Since normal cells in the lining of the bowel also divide rapidly, radiation treatment can stop those cells from growing, making it difficult for bowel tissue to repair itself. As bowel cells die and are not replaced, gastrointestinal problems develop over the next few days and weeks.

Acute Enteritis

Patients with acuteenteritis may have the following symptoms:

• Nausea.
• Vomiting.
• Abdominal cramps.
• Frequent urges to have a bowel movement.
• Rectal pain, bleeding, or mucus-like discharge.
• Watery diarrhea.

With diarrhea, the gastrointestinal tract does not function normally, and nutrients such as fat, lactose, bile salts, and vitamin B₁₂ are not well absorbed.

Symptoms of acute enteritis usually get better 2 to 3 weeks after treatment ends.

Chronic Enteritis

Patients with chronic enteritis may have the following symptoms:

• Wave-like abdominal pain.
• Bloody diarrhea.
• Frequent urges to have a bowel movement.
• Greasy and fatty stools.
• Weight loss.
• Nausea.
• Vomiting.

Less common symptoms of chronic enteritis are bowel obstruction, holes in the bowel, and heavy rectal bleeding.

Symptoms usually appear 6 to 18 months after radiation therapy ends. Before determining that chronic radiation enteritis is causing these symptoms, recurrent tumors need to be ruled out. The radiation history of the patient is important in making the correct diagnosis.

Assessment of Radiation Enteritis

Patients will be given a physical exam and be asked questions about the following:

• Usual pattern of bowel movements.
• Pattern of diarrhea, including when it started; how long it has lasted; frequency, amount, and type of stools; and other symptoms (such as gas, cramping, bloating, urgency, bleeding, and rectal soreness).
• Nutritional health of the patient, including height and weight, usual eating habits, any change in eating habits, amount of fiber in the diet, and signs of dehydration (such as poor skin tone, increased weakness, or feeling very tired).
• Current level of stress, ability to cope, and changes in lifestyle caused by the enteritis.

Treatment of Acute Radiation Enteritis

Treatment of acute enteritis includes treating the diarrhea, loss of fluids, poor absorption, and stomach or rectal pain. These symptoms usually get better with medications, changes in diet, and rest. If symptoms become worse even with this treatment, then cancer treatment may have to be stopped, at least temporarily.

Medications that may be prescribed include antidiarrheals to stop diarrhea, opioids to relieve pain, and steroid foams to relieve rectal inflammation and irritation. If patients with pancreatic cancer have diarrhea during radiation therapy, they may need pancreatic enzyme replacement, because not having enough of these enzymes can cause diarrhea.

Nutrition

Nutrition also plays a role in acute enteritis. Intestines damaged by radiation therapy may not make enough or any of certain enzymes needed for digestion, especially lactase. Lactase is needed for the digestion of milk and milk products. A lactose-free, low-fat, and low-fiber diet may help to control symptoms of acute enteritis.

Foods to avoid:

• Milk and milk products, except buttermilk and yogurt. Processed cheese may not cause problems because the lactose is removed during processing. Lactose-free milkshake supplements, such as Ensure, may also be used.
• Whole-bran bread and cereal.
• Nuts, seeds, and coconut.
• Fried, greasy, or fatty foods.
• Fresh and dried fruit and some fruit juices (such as prune juice).
• Raw vegetables.
• Rich pastries.
• Popcorn, potato chips, and pretzels.
• Strong spices and herbs.
• Chocolate, coffee, tea, and soft drinks with caffeine.
• Alcohol and tobacco.

Foods to choose:

• Fish, poultry, and meat that are cooked, broiled, or roasted.
• Bananas, applesauce, peeled apples, and apple and grape juices.
• White bread and toast.
• Macaroni and noodles.
• Baked, boiled, or mashed potatoes.
• Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
• Mild processed cheese, eggs, smooth peanut butter, buttermilk, and yogurt.

Helpful hints:

• Eat food at room temperature.
• Drink 3 liters (about 12 eight-ounce glasses) of fluid a day.
• Allow carbonated beverages to lose their fizz before drinking them.
• Add nutmeg to food to help decrease movement of the gastrointestinal tract.
• Start a low-fiber diet on the first day of radiation therapy.

Treatment of Chronic Radiation Enteritis

Treatment of the symptoms of chronic radiation enteritis is the same as treatment of acute radiation enteritis. Surgery is used to treat severe damage. Fewer than 2% of affected patients will need surgery to control their symptoms.

Two types of surgery may be used:

• Intestinalbypass, a procedure in which the doctor creates a new pathway for the flow of bowel contents.
• Complete removal of the diseased intestines.

The patient's general health and the amount of damaged tissue are considered before surgery is attempted, however, because wound healing is often slow and long-term tubefeeding may be needed. Even after surgery, many patients still have symptoms.

To lower the risk that chronic radiation enteritis will occur, different treatment methods are used to reduce the area that is exposed to radiation. Patients may be positioned to protect as much of the small bowel as possible from the radiation treatment, or may be asked to have a full bladder during treatment to help push the small bowel out of the way. The amount of radiation may be adjusted to deliver lower amounts more evenly or higher amounts to specific areas. If a patient has surgery, clips may be placed at the tumor site to help show the area to be irradiated.