Causes and Symptoms
Assessment of Radiation Enteritis
Treatment of Acute Radiation Enteritis
Treatment of Chronic Radiation Enteritis

Causes and Symptoms

Radiation therapy stops the growth of rapidly dividing cells, such as cancer cells. Since normal cells in the lining of the bowel also divide rapidly, radiation treatment can stop those cells from growing, making it difficult for bowel tissue to repair itself. As bowel cells die and are not replaced, gastrointestinal problems develop over the next few days and weeks.

Acute Enteritis

Patients with acute enteritis may have the following symptoms:

• Nausea.
• Vomiting.
• Abdominal cramps.
• Frequent urges to have a bowel movement.
• Rectal pain, bleeding, or mucus -like discharge.
• Watery diarrhea.

With diarrhea, the gastrointestinal tract does not function normally, and nutrients such as fat, lactose, bile salts, and vitamin B ₁₂ are not well absorbed.

Symptoms of acute enteritis usually get better 2 to 3 weeks after treatment ends.

Chronic Enteritis

Patients with chronic enteritis may have the following symptoms:

• Wave-like abdominal pain.
• Bloody diarrhea.
• Frequent urges to have a bowel movement.
• Greasy and fatty stools.
• Weight loss.
• Nausea.
• Vomiting.

Less common symptoms of chronic enteritis are bowel obstruction, holes in the bowel, and heavy rectal bleeding.

Symptoms usually appear 6 to 18 months after radiation therapy ends. Before determining that chronic radiation enteritis is causing these symptoms, recurrent tumors need to be ruled out. The radiation history of the patient is important in making the correct diagnosis.

Patients will be given a physical exam and be asked questions about the following:

• Usual pattern of bowel movements.
• Pattern of diarrhea, including when it started; how long it has lasted; frequency, amount, and type of stools; and other symptoms (such as gas, cramping, bloating, urgency, bleeding, and rectal soreness).
• Nutritional health of the patient, including height and weight, usual eating habits, any change in eating habits, amount of fiber in the diet, and signs of dehydration (such as poor skin tone, increased weakness, or feeling very tired).
• Current level of stress, ability to cope, and changes in lifestyle caused by the enteritis.

Treatment of acute enteritis includes treating the diarrhea, loss of fluids, poor absorption, and stomach or rectal pain. These symptoms usually get better with medications, changes in diet, and rest. If symptoms become worse even with this treatment, then cancer treatment may have to be stopped, at least temporarily.

Medications that may be prescribed include antidiarrheals to stop diarrhea, opioids to relieve pain, and steroid foams to relieve rectal inflammation and irritation. If patients with pancreatic cancer have diarrhea during radiation therapy, they may need pancreatic enzyme replacement, because not having enough of these enzymes can cause diarrhea.

Nutrition

Nutrition also plays a role in acute enteritis. Intestines damaged by radiation therapy may not make enough or any of certain enzymes needed for digestion, especially lactase. Lactase is needed for the digestion of milk and milk products. A lactose-free, low-fat, and low-fiber diet may help to control symptoms of acute enteritis.

Foods to avoid:

• Milk and milk products, except buttermilk and yogurt. Processed cheese may not cause problems because the lactose is removed during processing. Lactose-free milkshake supplements, such as Ensure, may also be used.
• Whole-bran bread and cereal.
• Nuts, seeds, and coconut.
• Fried, greasy, or fatty foods.
• Fresh and dried fruit and some fruit juices (such as prune juice).
• Raw vegetables.
• Rich pastries.
• Popcorn, potato chips, and pretzels.
• Strong spices and herbs.
• Chocolate, coffee, tea, and soft drinks with caffeine.
• Alcohol and tobacco.

Foods to choose:

• Fish, poultry, and meat that are cooked, broiled, or roasted.
• Bananas, applesauce, peeled apples, and apple and grape juices.
• White bread and toast.
• Macaroni and noodles.
• Baked, boiled, or mashed potatoes.
• Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
• Mild processed cheese, eggs, smooth peanut butter, buttermilk, and yogurt.

Helpful hints:

• Eat food at room temperature.
• Drink 3 liters (about 12 eight- ounce glasses) of fluid a day.
• Allow carbonated beverages to lose their fizz before drinking them.
• Add nutmeg to food to help decrease movement of the gastrointestinal tract.
• Start a low-fiber diet on the first day of radiation therapy.

Treatment of the symptoms of chronic radiation enteritis is the same as treatment of acute radiation enteritis. Surgery is used to treat severe damage. Fewer than 2% of affected patients will need surgery to control their symptoms.

Two types of surgery may be used:

• Intestinal bypass, a procedure in which the doctor creates a new pathway for the flow of bowel contents.
• Complete removal of the diseased intestines.

The patient's general health and the amount of damaged tissue are considered before surgery is attempted, however, because wound healing is often slow and long-term tubefeeding may be needed. Even after surgery, many patients still have symptoms.

To lower the risk that chronic radiation enteritis will occur, different treatment methods are used to reduce the area that is exposed to radiation. Patients may be positioned to protect as much of the small bowel as possible from the radiation treatment, or may be asked to have a full bladder during treatment to help push the small bowel out of the way. The amount of radiation may be adjusted to deliver lower amounts more evenly or higher amounts to specific areas. If a patient has surgery, clips may be placed at the tumor site to help show the area to be irradiated.

Glossary Terms

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Symptoms or signs that begin and worsen quickly; not chronic.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A substance used to treat diarrhea (frequent and watery bowel movements).

A fluid made by the liver and stored in the gallbladder. Bile is excreted into the small intestine, where it helps digest fat.

The organ that stores urine.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

A surgical procedure in which the doctor creates a new pathway for the flow of body fluids.

A substance found in the leaves and beans of the coffee tree, in tea, yerba mate, guarana berries, and in small amounts in cocoa. It can also be made in the laboratory, and is added to some soft drinks, foods, and medicines. Caffeine increases brain activity, alertness, attention, and energy. It may also increase blood pressure, heart rate, breathing rate, and the loss of water from the body in urine.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A disease or condition that persists or progresses over a long period of time.

To adjust to new situations and overcome problems.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Frequent and watery bowel movements.

The things a person eats and drinks.

The process of breaking down food into substances the body can use for energy, tissue growth, and repair.

A protein that speeds up chemical reactions in the body.

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

Liquid.

Refers to the stomach and intestines. Also called GI.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

Having to do with the intestines.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.

Treated with radiation.

An enzyme that breaks down lactose, a type of sugar found in milk and milk products.

A type of sugar found in milk and milk products.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

Blockage of a passageway.

A drug used to treat moderate to severe pain. Opioids are similar to opiates such as morphine and codeine, but they do not contain and are not made from opium.

A measure of weight (one-sixteenth pound) and volume (one-eighth cup).

A disease in which malignant (cancer) cells are found in the tissues of the pancreas. Also called exocrine cancer.

A protein secreted by the pancreas that aids in the digestion of food.

An exam of the body to check for general signs of disease.

A doctor's order for medicine or another intervention.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

Inflammation of the small intestine caused by radiation therapy to the abdomen, pelvis, or rectum. Symptoms include nausea, vomiting, abdominal pain and cramping, frequent bowel movements, watery or bloody diarrhea, fatty stools, and weight loss. Some of these symptoms may continue for a long time.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

By or having to do with the rectum. The rectum is the last several inches of the large intestine closest to the anus.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.

The part of the digestive tract that is located between the stomach and the large intestine.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

The material in a bowel movement. Stool is made up of food that was not digested, bacteria, mucus, and cells from the intestines. Also called feces.

The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.

A substance or product that is added to a person’s diet to make sure they get all the nutrients they need. It may include vitamins, minerals, protein, or fat, and may be given by mouth, by tube feeding, or into a vein.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A group or layer of cells that work together to perform a specific function.

A plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name is Nicotiana tabacum.

A type of enteral nutrition (nutrition that is delivered into the digestive system in a liquid form). For tubefeeding, a small tube may be placed through the nose into the stomach or the small intestine. Sometimes it is surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

A nutrient in the vitamin B complex that the body needs in small amounts to function and stay healthy. Vitamin B12 helps make red blood cells, DNA, RNA, energy, and tissues, and keeps nerve cells healthy. It is found in liver, meat, eggs, poultry, shellfish, milk, and milk products. Vitamin B12 is water-soluble (can dissolve in water) and must be taken in every day. Not enough vitamin B12 can cause certain types of anemia (a condition in which the number of red blood cells is below normal) and neurologic disorders. It is being studied with folate in the prevention and treatment of some types of cancer. Also called cobalamin and cyanocobalamin.

To eject some or all of the contents of the stomach through the mouth.

A break in the skin or other body tissues caused by injury or surgical incision (cut).