Radiation damage to the intestine

A special place among chronic enteritis of various etiologies is occupied by radiation enteritis caused by ionizing radiation. It can be one of the manifestations of radiation sickness or occur as a result of X-ray radiotherapy of malignant neoplasms of the abdominal cavity and pelvic organs.

Etiology and pathogenesis. Radiation sickness or radiation damage to a number of organs, including the intestines, develops with the use of nuclear weapons (the tragedy in Hiroshima and Nagasaki in 1945), violation of safety regulations and negligence with sources of ionizing radiation (events at the Chernobyl Nuclear Power Plant), irrational administration of large doses of radiation therapy. With local irradiation of the abdominal cavity and pelvic organs, the total dose of which exceeds 40 Gy (4000 rad), pathological changes may develop, mainly in the intestines. Most often, damage to the small and large intestines is combined, although an isolated process in one of these sections of the intestine is often observed.

Causes of radiation damage to the intestines

Clinic. Manifestations of radiation enteritis may appear quite early, during radiation therapy; sometimes soon after treatment, but their development is also possible several months or even years after its completion. Nausea, vomiting, bowel disorder in the form of diarrhea or constipation may be observed early. Involvement of the large intestine in the pathological process is due to tenesmus, the appearance of mucus and scarlet blood in the feces as a result of ulceration in the mucous membrane of the lower part of the intestine (10% of cases), the predominance of diarrhea at first, then constipation due to the early occurrence of strictures of the large intestine or rectum.

Symptoms of radiation damage to the intestines

Diagnosis of radiation enteritis and enterocolitis is aided by a carefully collected anamnesis. Evidence of radiation therapy or contact with ionizing radiation in the past allows for a high degree of probability of diagnosing radiation damage to the intestine. X-ray examination of abdominal organs can detect intestinal obstruction, edema of the small intestinal mucosa, dilation and hypotension of intestinal loops, and severe spasm of the rectum already in the early stages of radiation enteritis.

Diagnosis of radiation damage to the intestines

Treatment. Even with minimal signs of damage to the small intestine, broad-spectrum antibiotics are recommended; aspirin, which suppresses prostaglandin activity; agents that neutralize pancreatic secretion, a full diet during the entire period of radiation therapy. In the acute period, reducing the radiation dose by at least 10% can significantly reduce the symptoms of the disease.

Treatment of radiation damage to the intestines

Prevention of radiation enteritis and enterocolitis consists of observing safety regulations when in contact with sources of ionizing radiation, carefully working out individual doses of radiation using different types of tests for the radiosensitivity of organs and tissues. The following are important: methods of multi-field, cross, mobile irradiation, protective blocks, filters, rasters, wedges; changing the value of a single dose and the duration of intervals between radiation therapy sessions, split courses of irradiation; methods that allow healthy tissue to be mechanically moved away from the tumor; creating artificial hypoxia and prescribing radiosensitizing substances - oxygen, nitrofurans, etc.

The prognosis for radiation reactions of the intestine is usually favorable. In severe lesions of the small and large intestine, it is much more serious and depends on a number of factors (the method of irradiation, the localization and extent of the pathological process for which radiation therapy was performed, the severity of intestinal manifestations, etc.).

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