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)