Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

1264 Radiation Enteritis and Colitis

management

What to Do First

■Preventive measures and careful planning taken before radiation

therapy is delivered

General Measures

■Radiation therapy techniques to avoid tissue injury

■Prophylactic dietary changes including elemental diets or low-fat,

low-residue, lactose-free diets

■Prophylactic use of antioxidants such as vitamin E or radioprotectors

such as WR-2721 (amifostine)

specific therapy

■Control or ameliorate symptoms of acute or chronic radiation bowel

injury

Treatment Options

■Acute radiation enteritis and colitis

➣Symptoms usually reversible; supportive care only

➣Small radiation dose reduction (10%) may be sufficient

➣Mild diarrhea, abdominal cramping, and tenesmus managed

with antispasmodics, bulk-forming agents, sitz baths, and anti-

diarrheal agents (loperamide)

➣Sucralfate (4 g daily) for treatment of diarrhea

➣Cholestyramine a bile acid sequestrant for watery diarrhea due

to bile salt malabsorption (4–12 g/day)

➣Ondansetron and other anti-emetics can be used to treat nausea

➣5-ASA drugs (oral or enema form) such as mesalamine are inef-

fective at controlling tenesmus, diarrhea or hematochezia

■Chronic radiation enteritis

➣Acute small bowel obstruction (SBO) managed conservatively

➣Surgery used as a last resort for SBO (high complication rate)

➣Surgery for persistent SBO from adhesions or strictures

➣Complete, wide resection of the involved segment indicated, with

end-end anastomosis

➣Resection preferred over intestinal bypass procedures Surgery

also indicated for management of fistulas, hemorrhage, and per-

foration with peritonitis or intra-abdominal abscess Malabs orp-

tion from bacterial overgrowth treated with antibiotics

➣Bacterial overgrowth caused by severe obstruction or fistula usu-

ally requires surgery (resection or bypass)