This is what radiation enteritis is all about

Radiation enteritis is a common digestive system disease in daily life, but what exactly is this disease? Most people are not very clear about this. In fact, radiation enteritis is an intestinal inflammation caused by radiotherapy of malignant tumors in the pelvis, abdomen, and retroperitoneum, which is very harmful to human health.

Radiation enteritis is an intestinal complication caused by radiotherapy for pelvic, abdominal, and retroperitoneal malignant tumors. This disease is most common in cervical cancer, bladder cancer, and advanced colorectal cancer after cobalt or radium radiotherapy, with a secondary rate of 10% to 60%. Most cases are due to increased sensitivity of the small and large intestine to radiation therapy. It can affect the small intestine, colon and rectum respectively, so it is also called radiation rectal, colon and enteritis.

Radiation sickness is generally divided into acute and chronic types based on the amount of radiation dose to the intestines, the length of time, and the severity of the onset. Depending on where the radiation source is placed inside or outside the body, it can be divided into external radiation sickness and internal radiation sickness. In the early stage, the renewal of intestinal mucosal cells is inhibited, and then the walls of small arteries swell and become blocked, causing intestinal wall ischemia and mucosal erosion. In the late stage, the intestinal wall causes fibrosis, intestinal stenosis or perforation, and abscesses, fistulas and intestinal adhesions form in the abdominal cavity.

Generally, the disease rarely occurs when the total radiation dose is below 3000 rad. Symptoms occur when the total amount of intraperitoneal radiotherapy exceeds 4000 rad, and the incidence rate is as high as 36% if it reaches 7000 rad or more. Symptoms may appear early in treatment, soon after treatment ends, or months to years after treatment.

1. Early symptoms

Gastrointestinal symptoms may appear early due to the nervous system's response to radiation. It usually occurs within 1 to 2 weeks after the start of radiotherapy. Nausea, vomiting, diarrhea, mucus or blood in the stool. Involvement of the rectum is accompanied by tenesmus. Persistent blood in the stool can cause iron deficiency anemia. Constipation is uncommon. Occasionally low fever. Spasmodic abdominal pain indicates involvement of the small intestine. Sigmoidoscopy may reveal mucosal edema and congestion, and in severe cases, erosion or ulcers.

2. Late symptoms

If the acute symptoms persist or do not heal until 6 months to several years after the end of radiotherapy, it indicates that the disease is continuing and will eventually develop into fibrosis or stenosis. Symptoms during this period may occur as early as six months after radiotherapy or as late as 10 or even 30 years later, and are often related to intestinal wall vasculitis and subsequent lesions.

(1) Colon and proctitis often occur 6 to 18 months after irradiation. Symptoms such as diarrhea, blood in the stool, mucus in the stool, tenesmus, narrowing of the stool, progressive constipation, or abdominal pain indicate intestinal stenosis. Severe lesions may form fistulas with adjacent organs, such as rectovaginal fistulas, in which feces are discharged from the vagina. Rectal intestinal fistulas may result in chyme being discharged mixed with feces, and intestinal perforation may also cause peritonitis, abdominal or pelvic abscesses. Intestinal obstruction may occur due to intestinal narrowing and entanglement of intestinal loops.

(2) Enteritis When the small intestine is severely damaged by radiation, severe abdominal pain, nausea, vomiting, abdominal distension, and bloody diarrhea may occur. However, the main symptoms in the late stage are malabsorption, accompanied by intermittent abdominal pain, steatorrhea, weight loss, fatigue, anemia, etc.