Radiation proctitis natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Radiation proctitis}} | {{Radiation proctitis}} | ||
{{CMG}} | {{CMG}} {{AE}} [[User:Rekha|Rekha, M.D.]], {{MIR}} | ||
==Overview== | ==Overview== | ||
The symptoms and extent of radiation proctitis are variable and usually develop insidiously.The symptoms depend on the dose and duration of the [[radiation]] and how sensitive the bowel is to radiation.Common complications of radiation proctitis include [[ | The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the [[radiation]] and how sensitive the bowel is to radiation. Common complications of radiation proctitis include [[intestinal obstruction]] due to stricture, [[fecal incontinence]] due to overflow and [[Fistulae|fistula]] formation due to concomitant injury to nearby organs. The [[prognosis]] of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment. | ||
The [[prognosis]] of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment. | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
=== Natural History === | === Natural History === | ||
* The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the [[radiation]] and how sensitive the bowel is to radiation. <ref name="pmid66036282">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }}</ref> | * The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the [[radiation]] and how sensitive the bowel is to radiation.<ref name="pmid66036282">{{cite journal| author=Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN| title=The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. | journal=Q J Med | year= 1983 | volume= 52 | issue= 205 | pages= 40-53 | pmid=6603628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6603628 }}</ref> | ||
* In acute radiation proctitis symptoms usually start shortly after commencement of [[radiation therapy]] and progress reaching a peak within 6 weeks.In most cases, the symptoms of acute radiation colitis are self-limiting however | * In acute radiation proctitis symptoms usually start shortly after commencement of [[radiation therapy]] and progress reaching a peak within 6 weeks.In most cases, the symptoms of acute radiation colitis are self-limiting however up to 20 percent of patients with acute radiation proctitis will have symptoms that are severe enough to require an interruption in [[radiation]] treatment. | ||
* The chronic radiation proctitis has delayed onset and symptoms often become noticeable months to years after the completion of [[radiotherapy]]. The symptoms may occasionally follow acute radiation colitis. However, previous acute radiation colitis does not increase the risk of a patient developing chronic radiation colitis.Also, absence of acute radiation colitis, does not prevent chronic radiation colitis from occurring. Treatment is required for chronic radiation colitis because resolution of the symptoms is uncommon without intervention<ref name="pmid8677984">{{cite journal| author=Babb RR| title=Radiation proctitis: a review. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 7 | pages= 1309-11 | pmid=8677984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8677984 }}</ref> | * The chronic radiation proctitis has delayed onset and symptoms often become noticeable months to years after the completion of [[radiotherapy]]. The symptoms may occasionally follow acute radiation colitis. However, previous acute radiation colitis does not increase the risk of a patient developing chronic radiation colitis. Also, absence of acute radiation colitis, does not prevent chronic radiation colitis from occurring. Treatment is required for chronic radiation colitis because resolution of the symptoms is uncommon without intervention.<ref name="pmid8677984">{{cite journal| author=Babb RR| title=Radiation proctitis: a review. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 7 | pages= 1309-11 | pmid=8677984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8677984 }}</ref> | ||
=== Complications === | === Complications === | ||
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* [[Failure to thrive]] | * [[Failure to thrive]] | ||
* [[Sepsis]], due to loss of the mucosal protective barrier | * [[Sepsis]], due to loss of the mucosal protective barrier | ||
* Concomitant injury to the genitourinary tract or small bowel may lead to intestinal obstruction, small intestinal bacterial overgrowth, urethral stenosis, and cystitis. | * Concomitant injury to the genitourinary tract or small bowel may lead to [[intestinal obstruction]], [[small intestinal bacterial overgrowth]], [[Urethra|urethral stenosis]], and [[cystitis]]. | ||
* | * | ||
* Risk of development of the secondary malignancy | * Risk of development of the secondary [[malignancy]] | ||
=== Prognosis === | === Prognosis === | ||
The [[prognosis]] of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment. | The [[prognosis]] of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment. | ||
* Acute radiation colitis is usually self-limiting, with resolution of symptoms few weeks after cessation of radiotherapy. | * Acute radiation colitis is usually self-limiting, with resolution of symptoms few weeks after cessation of [[radiotherapy]]. | ||
* Chronic radiation colitis is progressive and difficult to manage. The patients may develop secondary radiation-associated malignancy which has a poor prognosis due to late diagnosis. | * Chronic radiation colitis is progressive and difficult to manage. The patients may develop secondary radiation-associated malignancy which has a poor prognosis due to late diagnosis. | ||
Latest revision as of 23:53, 6 November 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rekha, M.D., Mahshid Mir, M.D. [2]
Overview
The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the radiation and how sensitive the bowel is to radiation. Common complications of radiation proctitis include intestinal obstruction due to stricture, fecal incontinence due to overflow and fistula formation due to concomitant injury to nearby organs. The prognosis of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment.
Natural History, Complications and Prognosis
Natural History
- The symptoms and extent of radiation proctitis are variable and usually develop insidiously. The symptoms depend on the dose and duration of the radiation and how sensitive the bowel is to radiation.[1]
- In acute radiation proctitis symptoms usually start shortly after commencement of radiation therapy and progress reaching a peak within 6 weeks.In most cases, the symptoms of acute radiation colitis are self-limiting however up to 20 percent of patients with acute radiation proctitis will have symptoms that are severe enough to require an interruption in radiation treatment.
- The chronic radiation proctitis has delayed onset and symptoms often become noticeable months to years after the completion of radiotherapy. The symptoms may occasionally follow acute radiation colitis. However, previous acute radiation colitis does not increase the risk of a patient developing chronic radiation colitis. Also, absence of acute radiation colitis, does not prevent chronic radiation colitis from occurring. Treatment is required for chronic radiation colitis because resolution of the symptoms is uncommon without intervention.[2]
Complications
Common complications of chronic radiation proctitis include:
- Anemia
- Intestinal obstruction due to stricture
- Fistula
- Fecal incontinence due to overflow
- Malabsorption
- Failure to thrive
- Sepsis, due to loss of the mucosal protective barrier
- Concomitant injury to the genitourinary tract or small bowel may lead to intestinal obstruction, small intestinal bacterial overgrowth, urethral stenosis, and cystitis.
- Risk of development of the secondary malignancy
Prognosis
The prognosis of radiation colitis varies with the sub-type, severity, duration and responsiveness to treatment.
- Acute radiation colitis is usually self-limiting, with resolution of symptoms few weeks after cessation of radiotherapy.
- Chronic radiation colitis is progressive and difficult to manage. The patients may develop secondary radiation-associated malignancy which has a poor prognosis due to late diagnosis.
References
- ↑ Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN (1983). "The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients". Q J Med. 52 (205): 40–53. PMID 6603628.
- ↑ Babb RR (1996). "Radiation proctitis: a review". Am J Gastroenterol. 91 (7): 1309–11. PMID 8677984.