Radiation enteritis

Causes

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

Exams and Tests

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

Tests may include:

• Barium x-ray examination
• Sigmoidoscopy or colonoscopy
• Upper endoscopy

Treatment

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.

Outlook (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.

Possible Complications

• Bleeding and anemia
• Dehydration
• Iron deficiency
• Malabsorption
• Malnutrition
• Weight loss

When to Contact a Medical Professional

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.

Alternative Names

Radiation enteropathy; Radiation-induced small bowel injury; Post-radiation enteritis

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.

Update Date: 8/10/2012

Updated 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.