Effect of pelvic irradiation on gastrointestinal function: A prospective longitudinal study

doi:10.1016/0002-9343(93)90309-D

The American Journal of Medicine

Volume 95, Issue 4, October 1993, Pages 397-406

https://doi.org/10.1016/0002-9343(93)90309-D Get rights and content

Abstract

purpose: Although radiation enteritis is a well-recognized sequel of therapeutic irradiation, the effects of abdominal and/or pelvic irradiation on gastrointestinal function are poorly defined and treatment is often unsuccessful. To determine both the short- and long-term effects of therapeutic irradiation on gastrointestinal function, we performed a prospective study.

patients and methods: Various aspects of gastrointestinal function were evaluated in 27 patients with potentially curable malignant disease (23 female, 4 male) before the commencement of, during, and 6 to 8 weeks, 12 to 16 weeks, and 1 to 2 years following completion of radiation therapy. Seventeen patients received pelvic irradiation alone and 10 patients received both abdominal and pelvic irradiation. Gastrointestinal symptoms, absorption of bile acid, vitamin B₁₂, lactose, and fat, gastric emptying, small-intestinal and whole-gut transit, stool weight, and intestinal permeability were measured. Results were compared with those obtained in 18 normal volunteers.

results: All 27 patients completed at least 2 series of measurements and 18 patients completed all 5 series of experiments. During radiation treatment, increased stool frequency (p <0.001) was associated with decreased bile acid and vitamin B₁₂ absorption (p <0.001 for both), increased fecal fat excretion (p <0.05), an increased prevalence of lactose malabsorption (p <0.01), and more rapid small-intestinal (p <0.01) and wholegut (p <0.05) transit. Although there was improvement in most of these changes with time, at 1 to 2 years after the completion of irradiation, the frequency of bowel actions was greater (p <0.001), bile acid absorption was less (p <0.05), and small-intestinal transit was more rapid (p <0.01) when compared with that of baseline and the normal subjects. At this time, at least 1 parameter of gastrointestinal function was abnormal in 16 of the 18 patients. Stool weight was greater (p <0.05) and whole-gut transit faster (p <0.01) in patients who received both pelvic and abdominal irradiation, when compared with those who received pelvic irradiation alone. Stool frequency (p <0.001) and fecal fat excretion (p <0.05) were greater in those patients who had surgery before radiation therapy.

conclusion: Pelvic irradiation is usually associated with widespread, persistent effects on gastrointestinal function.

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^☆: This study was supported by the National Health and Medical Research Council of Australia and the Anticancer Foundation of the Universities of South Australia.

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Effect of pelvic irradiation on gastrointestinal function: A prospective longitudinal study☆

Abstract

Radiother Oncol

Int J Radiat Oncol Biol Phys

Lancet

Am J Clin Nutr

Gastroenterology

Gastroenterology

Gastroenterology

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Clin Radiol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Radiation enteritis

Surg Gynecol Obstet

Chronic radiation injury to the intestine: a clinico-pathological study

Aust N Z J Med

Tolerance of the intestine to radiation therapy

Surg Gynecol Obstet

Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy

Dig Dis Sci

The mechanism of diarrhea resulting from pelvic and abdominal radiotherapy; a prospective study using selenium-75 labelled conjugated bile acid and cobalt-58 labelled cyanocobalamin

Br J Radiol

Determination of the fat content of faeces