Abstract
Background/Objectives:
Chronic radiation enteritis (RE) has been reported in up to 20% of patients receiving pelvic radiotherapy and can lead to intestinal failure (IF), accounting for 3.9% of new registrants for home parenteral nutrition (HPN) in the UK annually. Our aim is to report nutritional and survival outcomes for patients with RE referred to a national IF unit.
Subjects/Methods:
A retrospective study of all new admissions over a 13-year period at the Intestinal Failure Centre, Manchester, UK. Data are presented as median (range).
Results:
Twenty-three (3.8%) of 611 patients were admitted with IF secondary to RE. The primary site of malignancy was genitourinary in 17 (74%) patients. Radiotherapy was administered 9.5 (1–42) years previously. Patients underwent 2 (1–5) laparotomies prior to intestinal failure unit (IFU) admission. Twelve (52%) patients were admitted with intestinal obstruction and 11 (48%) with intractable weight loss and/or high output fistulae/stomas. Additional conditions contributing to IF were noted in 11 (48%) patients. Twenty-two (96%) patients had 2 (1–5) laparotomies prior to IFU referral. At discharge, 5 (22%) patients resumed oral diet without the need for artificial nutrition support, 3 (13%) required enteral feeding and 13 (56%) commenced HPN. The 10-year survival of the patient cohort was 48.2%.
Conclusions:
Surgical intervention is infrequently required, whereas the majority of patients with IF secondary to RE require long-term HPN. The judicious use of surgery in selected patients, coupled with an aggressive medical strategy to detect and treat contributing factors, and optimal enteral feeding may allow a modest proportion of patients with IF secondary to RE to achieve independence from PN.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Andreyev HJ, Vlavianos P, Blake P, Dearnaley D, Norman AR, Tait D . Gastrointestinal symptoms after pelvic radiotherapy: role for the gastroenterologist? Int J Radiat Oncol Biol Phys 2005; 62: 1464–1471.
Andreyev J . Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 2005; 54: 1051–1054.
Gami B, Harrington K, Blake P, Dearnaley D, Tait D, Davies J et al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 2003; 18: 987–994.
Lundby L, Jensen V, Overgaard J, Laurberg S . Long-term colorectal function after postoperative radiotherapy for colorectal cancer. Lancet 1997; 350: 564.
Dahlberg M, Glimelius B, Graf W, Påhlman L . Preoperative irradiation affects functional results after surgery for rectal cancer. Dis Colon Rectum 1998; 41: 543–551.
Olopade FA, Norman A, Blake P, Dearnaley DP, Harrington KJ, Khoo V et al. A modified Inflammatory Bowel Disease questionnaire and the Vaizey Incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy. Br J Cancer 2005; 92: 1663–1670.
Kozelsky T, Meyers G, Sloan J, Shanahan TG, Dick SJ, Moore RL et al. Phase III double-blind study of glutamine versus placebo for the prevention of acute diarrhea in patients receiving pelvic radiation therapy. J Clin Oncol 2003; 21: 1669–1674.
Andreyev HJ, Davidson SE, Gillespie C, Allum WH, Swarbrick E et al. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut 2012; 61: 179–192.
Galland RB, Spencer J . The natural history of clinically established radiation enteritis. Lancet 1985; 1: 1257–1258.
MacNaughton WK . Review article: new insights into the pathogenesis of radiation-induced intestinal dysfunction. Aliment Pharmacol Ther 2000; 14: 523–528.
Rodier JF . Radiation enteropathy—incidence, aetiology, risk factors, pathology and symptoms. Tumori 1995; 81 (Suppl), 122–125.
Yeoh EK, Horowitz M . Radiation enteritis. Surg Gynecol Obstet 1987; 165: 373–379.
Wellwood JM, Jackson BT . The intestinal complications of radiotherapy. Br J Surg 1973; 60: 814–818.
Libotte F, Autier P, Delmelle M, Gozy M, Pector JC, Van Houtte P et al. Survival of patients with radiation enteritis of the small and the large intestine. Acta Chir Belg 1995; 95 (Suppl), 190–194.
DeCosse JJ, Rhodes RS, Wentz WB, Reagan JW, Dworken HJ, Holden WD . The natural history and management of radiation induced injury of the gastrointestinal tract. Ann Surg 1969; 170: 369–384.
Theis VS, Sripadam R, Ramani V, Lal S . Chronic radiation enteritis. Clin Oncol (R Coll Radiol) 2010; 22: 70–83.
Regimbeau JM, Panis Y, Gouzi JL, Fagniez PL, French University Association for Surgical Research. Operative and long term results after surgery for chronic radiation enteritis. Am J Surg 2001; 182: 237–242.
Galland RB, Spencer J . Surgical management of radiation enteritis. Surgery 1986; 99: 133–139.
Girvent M, Carlson GL, Anderson I, Shaffer J, Irving M, Scott NA . Intestinal failure after surgery for complicated radiation enteritis. Ann R Coll Surg Engl 2000; 82: 198–201.
Trevor Smith AM, Hirst A, Stratton R, Baxter J . Annual BANS Report 2011. BAPEN, 2011.
Umar RK, Buchman L . Inflammatory bowel disease and the short bowel syndrome (Chapter 11). In: Intestinal Failure: Diagnosis, Management and Transplantation, Wiley: New York, 2008, pp 99–106.
Buchman A . The medical and surgical management of short bowel syndrome. MedGenMed 2004; 6: 12.
Lal S, Teubner A, Shaffer JL . Review article: intestinal failure. Aliment Pharmacol Ther 2006; 24: 19–31.
Cross MJ, Frazee RC . Surgical treatment of radiation enteritis. Am Surg 1992; 58: 132–135.
van Halteren HK, Gortzak E, Taal BG, Helmerhorst TJ, Aleman BM, Hart AA et al. Surgical intervention for complications caused by late radiation damage of the small bowel: a retrospective analysis. Eur J Surg Oncol 1993; 19: 336–341.
Gavazzi C, Bhoori S, Lovullo S, Cozzi G, Mariani L . Role of home parenteral nutrition in chronic radiation enteritis. Am Gastroenterol 2006; 101: 374–379.
Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H . Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 2000; 87: 467–471.
van Goor H . Consequences and complications of peritoneal adhesions. Colorectal Dis 2007; 9 (Suppl 2), 25–34.
Moran BJ . Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl 2010; 57: 47–50.
Vantini I, Benini L, Bonfante F, Talamini G, Sembenini C, Chiarioni G et al. Survival rate and prognostic factors in patients with intestinal failure. Dig Liver Dis 2004; 36: 46–55.
Scolapio JS, Ukleja A, Burnes JU, Kelly DG . Outcome of patients with radiation enteritis treated with home parenteral nutrition. Am J Gastroenterol 2002; 97: 662–666.
Baxter JP, Fayers PM, McKinlay AW . A review of the quality of life of adult patients treated with long-term parenteral nutrition. Clin Nutr 2006; 25: 543–553.
Acknowledgements
The authors received no specific funding for this article.
Author contributions
RK—acquistion of data, interpretation, drafting and revising the article. VT, MD—interpretation of data, drafting and revising the article. AT, IDA, JLS, GLC, SL—conception and design, revising the article. All authors have read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Conference presentation: Part of the data were presented as a poster at Gastro 2009, London, UK during 23–25 November 2009.
Rights and permissions
About this article
Cite this article
Kalaiselvan, R., Theis, V., Dibb, M. et al. Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre. Eur J Clin Nutr 68, 166–170 (2014). https://doi.org/10.1038/ejcn.2013.251
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2013.251
Keywords
This article is cited by
-
Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management
Techniques in Coloproctology (2020)
-
SEOM clinical guidelines on nutrition in cancer patients (2018)
Clinical and Translational Oncology (2019)