Radiation colitis: Difference between revisions
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Endoscopy should be gentle and with care especially in acute radiation colitis. | Endoscopy should be gentle and with care especially in acute radiation colitis. | ||
*The mucosa may appear erythematous or pale, is edematous, friable | *The mucosa may appear erythematous or pale, is edematous, friable with or without small erosions in acute radiation colitis. | ||
*In chronic radiation colitis, mucosa atrophy, fibrosis, obliterative arteritis, stenosis, strictures, fistula and ulcers are seen. | *In chronic radiation colitis, mucosa atrophy, fibrosis, obliterative arteritis, stenosis, strictures, fistula and ulcers are seen. | ||
Revision as of 21:23, 5 November 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Qasim Salau, M.B.B.S., FMCPaed [2]
Synonyms and keywords:
Overview
Radiation therapy is a common treatment modality for Abdominal and pelvic malignancy. Radiation colitis may complicate this radiotherapy. Radiation colitis tends to develop insidiously and it is often progressive.
Historical Perspective
Classification
Pathophysiology
- Occur following radiation therapy for Abdominal and pelvic malignancies .[1][2][3][4]
- More common with radiation doses higher than 45Gy.[4]
- The main site of damage is the DNA. May also affect RNA, proteins and cell membranes.
- Injury occur few hours to days, up to three months after irradiation in acute radiation colitis. It affects rapidly dividing cells of the epithelium and mucosa. This leads to cell death, recruitment and activation of polymorphonuclear (PMN) inflammatory cells, mucosal edema and damage to small blood vessels. It is usually transient and self limiting, with regeneration of the epithelium.
- In chronic radiation colitis, mesenchymal tissue is involved. The damage is progressive with atrophy of the mucosa, fibrosis of the intestinal wall, obliteration of small arteries, chronic ischemia, ulcers, strictures and fistula formation. This changes usually occur three months to years after radiation. Secondary colonic malignancy may occur.
Genetics
There is no specific genetic cause for radiation colitis.
Gross Pathology
Endoscopy should be gentle and with care especially in acute radiation colitis.
- The mucosa may appear erythematous or pale, is edematous, friable with or without small erosions in acute radiation colitis.
- In chronic radiation colitis, mucosa atrophy, fibrosis, obliterative arteritis, stenosis, strictures, fistula and ulcers are seen.
Microscopic Histopathology
Histopathological findings of radiation colitis may be categorized into the following
- Acute: Reduced mitosis, increased apoptosis bodies, mucin depletion, eosinophilia, presence of crypt abscesses and evidence of regeneration
- Chronic: Dilated capillaries and lymphatics, hyaline fibrosis, atypical fibroblast and endothelial cells and distortion of the crypts.
Differentiating radiation colitis from other Diseases
Symptoms of acute radiation proctitis may overlap with other causes of acute colitis, but prior history of radiation will help in distinguishing the cause. Differential diagnosis of acute radiation colitis include:
- Allergic colitis
- Chemical colitis
- NSAID induced colitis
- Ischemic colitis
Differential diagnosis of chronic radiation colitis include:
- Ischemic colitis
- Inflammatory bowel disease
Epidemiology and Demographics
Age
Gender
Race
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
References
- ↑ Keith NM, Whelan M (1926). "A STUDY OF THE ACTION OF AMMONIUM CHLORID AND ORGANIC MERCURY COMPOUNDS". J Clin Invest. 3 (1): 149–202. doi:10.1172/JCI100072. PMC 434619. PMID 16693707.
- ↑ Bansal N, Soni A, Kaur P, Chauhan AK, Kaushal V (2016). "Exploring the Management of Radiation Proctitis in Current Clinical Practice". J Clin Diagn Res. 10 (6): XE01–XE06. doi:10.7860/JCDR/2016/17524.7906. PMC 4963751. PMID 27504391.
- ↑ Nelamangala Ramakrishnaiah VP, Krishnamachari S (2016). "Chronic haemorrhagic radiation proctitis: A review". World J Gastrointest Surg. 8 (7): 483–91. doi:10.4240/wjgs.v8.i7.483. PMC 4942748. PMID 27462390.
- ↑ 4.0 4.1 Do NL, Nagle D, Poylin VY (2011). "Radiation proctitis: current strategies in management". Gastroenterol Res Pract. 2011: 917941. doi:10.1155/2011/917941. PMC 3226317. PMID 22144997.