Radiation enteritis is damage to the lining of the intestines (bowels) due to radiation therapy, a type of cancer treatment.
Alternative Names
Radiation enteropathy; Radiation-induced small bowel injury; Post-radiation enteritis
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. They can first occur during or shortly after radiation treatment (called acute radiation enteritis), or long after the treatment.
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
Most of the time, these symptoms get better within 2 - 3 months after radiation treatment ends.
When symptoms become long-term (chronic), other problems may include:
Abdominal pain
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.
Starting a low-fiber diet on the first day of radiation treatment can be helpful. The best choice of foods depends on what symptoms you have.
Avoiding the following foods may help with symptoms:
Alcohol and tobacco
Almost all milk products
Coffee, tea, chocolate, and sodas 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. However, medications such as cholestyramine, diphenoxylate-atropine, loperamide, or sucralfate may be helpful. 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 within 2 - 3 months after treatment ends.
However, when this condition develops, symptoms may last for a long period of time. Long-term (chronic) enteritis is rarely curable.
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.
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.
National Cancer Institute. Gastrointestinal Complications PDQ. Updated July 18, 2012.
Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 144.
Review Date:
8/10/2012
Reviewed By:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; 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. Health Solutions, Ebix, Inc.
