Radiation of the intestine

A special place among chronic enteritis of various etiology is radiation, or radiation, enteritis caused by ionizing radiation. It can be one of the manifestations of radiation sickness or arise as a result of X-ray therapy of malignant neoplasms of the abdominal cavity and pelvis.

Etiology and pathogenesis. Radiation disease or radiation damage to a number of organs, including the intestine, develops with the use of nuclear weapons (the tragedy in Hiroshima and Nagasaki in 1945), violation of safety rules and negligence with sources of ionizing radiation (events at the Chernobyl nuclear power plant), irrational the appointment of large doses of radiation therapy. With local irradiation of the abdominal and pelvic organs, the total dose of which exceeds 40 Gy (4000 rad), pathological changes can develop, mainly in the intestine. Most often, the defeat of the small and large intestine is combined, although there is often an isolated process in one of these parts of the intestine.

Causes of radiation injuries of the intestine 

Clinic. Manifestations of radiation enteritis can occur quite early, during the period of radiotherapy; sometimes shortly after treatment, but their development is possible even after several months and even years after its completion. Early nausea, vomiting, upset of the stool in the form of diarrhea or constipation may occur. Involvement in the pathological process of the colon is caused by tenesmus, the appearance of mucus and scarlet blood in feces as a result of the formation of ulcers in the mucosa of the lower intestinal segment (10% of cases), predominance of diarrhea at first, then constipation due to the early appearance of strictures of the colon or rectum.

Symptoms of intestinal radiation injuries

Diagnosis of radiation enteritis and enterocolitis helps a carefully collected history. The establishment of radiation therapy or contact with ionizing radiation in the past makes it possible to diagnose radiation damage to the intestine with a high degree of probability. X-ray examination of the abdominal organs already in the early stages of radiation enteritis can detect intestinal obstruction, edema of the small intestine mucosa, enlargement and hypotension of the intestinal loops, expressed spasm of the rectum.

Diagnosis of radiation damage of the intestine

Treatment. Even with minimal signs of involvement in the small intestine, broad-spectrum antibiotics are recommended; aspirin, the inhibitory activity of prostaglandins; drugs that neutralize pancreatic secretion, a full-fledged diet throughout the period of radiation therapy. In an acute period, a reduction in the radiation dose of at least 10% can significantly reduce the symptoms of the disease.

Treatment of intestinal radiation injuries

Prevention of radiation enteritis and enterocolitis consists in the observance of safety rules in contact with sources of ionizing radiation, careful testing of individual doses of radiation with the use of different types of samples for the radiosensitivity of organs and tissues. In this case, methods of multipole, cross, mobile irradiation, protective blocks, filters, rasters, wedges are important; change in the value of a single dose and the duration of intervals between radiotherapy sessions, split irradiation courses; ways to mechanically remove healthy tissue from the tumor; creation of artificial hypoxia and the appointment of radiosensitizing substances - oxygen, nitrofurans, etc.

The prognosis for radiation intestinal reactions is often favorable. With severe lesions of the small and large intestine, it is much more serious and depends on a number of factors (the way of irradiation, the localization and the vastness of the pathological process, in connection with which radiation therapy, the severity of intestinal manifestations, etc.).

[1], [2], [3], [4], [5]