Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre.

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.

• Authors: R Kalaiselvan, V S Theis, M Dibb, A Teubner, I D Anderson, J L Shaffer, G L Carlson, S Lal
• Journal: European journal of clinical nutrition (Eur J Clin Nutr) Vol. 68 Issue 2 Pg. 166-70 (Feb 2014) ISSN: 1476-5640 [Electronic] England
• PMID: 24327124 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Enteritis (etiology)
• Female
• Humans
• Intestinal Diseases (etiology, therapy)
• Intestinal Fistula (etiology, surgery, therapy)
• Intestinal Obstruction (etiology, surgery, therapy)
• Male
• Middle Aged
• Nutrition Therapy
• Parenteral Nutrition, Home
• Radiotherapy (adverse effects)
• Retrospective Studies
• Short Bowel Syndrome (etiology, surgery, therapy)
• Treatment Outcome
• United Kingdom
• Urogenital Neoplasms (radiotherapy)