Radiation enteritis, or radiation-induced bowel disease, results from damage to the lining of the intestines caused by radiation therapy. This damage leads to various gastrointestinal symptoms that can significantly impact a patient's quality of life. Radiation therapy, while effective in treating cancers, particularly in the abdominal and pelvic areas, can inadvertently harm healthy intestinal cells. Managing radiation enteritis often involves dietary adjustments to alleviate symptoms and promote healing.
Understanding Radiation Enteritis
Radiation enteritis occurs when radiation therapy damages the intestinal lining. This is most common in individuals undergoing cancer treatment involving radiation to the abdominal region. Symptoms can manifest during treatment, shortly after, or even months or years later. The condition can be either acute, resolving within weeks after treatment, or chronic, persisting for an extended period.
Acute vs. Chronic Radiation Enteritis
Acute radiation enteritis typically presents with symptoms like diarrhea, nausea, and abdominal pain during radiation therapy, subsiding shortly after treatment completion. Chronic radiation enteritis, on the other hand, involves long-term damage, leading to persistent issues such as chronic diarrhea, incontinence, bowel urgency, and malabsorption. Chronic radiation enteritis is the technical term for the long-term damage that can result after radiation therapy for rectal cancer.
Risk Factors
Several factors increase the risk of developing radiation enteritis. These include receiving radiation therapy over a large abdominal area, high radiation doses, concurrent chemotherapy, prior abdominal surgeries, diabetes, high blood pressure, and tobacco use.
Symptoms of Radiation Enteritis
Symptoms vary depending on the affected part of the intestines and can be exacerbated by factors like concurrent chemotherapy or high radiation doses. Common symptoms include:
Read also: Eating During Radiation
- Changes in bowel movements: Bleeding or mucus from the rectum, diarrhea or watery stools, and frequent urges to have a bowel movement.
- Pain: Rectal pain, especially during bowel movements and abdominal pain.
- Other symptoms: Loss of appetite, nausea, and vomiting.
Chronic symptoms can include abdominal pain, bloody diarrhea, greasy stools, and weight loss.
Diagnostic Tests
Diagnosing radiation enteritis involves a physical examination, a review of the patient's medical history, and specific tests. These tests may include:
- Endoscopy: Upper endoscopy or colonoscopy to visualize the intestinal lining.
- Imaging Tests: CT scans, MRI, or capsule endoscopy to identify changes in the small intestine.
General Dietary Recommendations
Dietary management is crucial for alleviating the symptoms of radiation enteritis. The primary goals are to reduce irritation to the intestines, manage diarrhea, and ensure adequate nutrient intake.
Fluid Intake
Maintaining adequate hydration is essential, especially when diarrhea is present. Drink at least three quarts (12 cups) of liquid each day to prevent dehydration. Liquids should be consumed at room temperature and sipped slowly throughout the day, avoiding large quantities at once and sugary beverages. Plain broth, Gatorade, decaf coffee, decaf tea, and water are good choices.
Meal Frequency and Size
Eating small, frequent meals and snacks helps avoid overloading the digestive tract. This approach allows the intestines to process food more efficiently.
Read also: Managing Radiation Diarrhea with Diet
Food and Symptom Diary
Keeping a detailed food record, including what and how much is eaten, whether foods are homemade or from a restaurant, food temperature, and time of day, is beneficial. Specific details about the symptoms experienced should also be recorded. Discussing this diary with a Registered Dietitian Nutritionist (RDN) can help identify trigger foods.
Soluble Fiber
Supplementing the diet with soluble fiber products like psyllium, guar gum, or inulin can be beneficial. Starting a fiber supplement at the beginning of radiation therapy can help manage symptoms. Begin with one dose per day, following package instructions.
Foods to Avoid
Certain foods can exacerbate symptoms and should be avoided or minimized:
- Hard-to-digest foods: Popcorn, peas, corn, raw vegetables, and "gassy" vegetables from the cruciferous and allium families.
- Sugar alcohols: Sugar-free foods, gum, and candy made with sugar alcohols like sorbitol, mannitol, and xylitol.
- Insoluble fiber: Fresh fruit, raw vegetables, and whole-grain breads and cereals.
- Alcohol and tobacco
- Almost all milk products
- Coffee, tea, chocolate, and sodas with caffeine
- Fried, greasy, or fatty foods
- Nuts and seeds
- Rich pastries and baked goods
- Some fruit juices
- Strong spices
Foods to Include
Focus on foods that are gentle on the digestive system and can help manage symptoms:
- Soluble fiber-rich foods: Oatmeal or oat bran, bananas, applesauce, and canned peaches and pears.
- Well-cooked, peeled fruits and vegetables: Consider adding them to soups or smoothies.
- Yogurt with live active cultures, buttermilk, or kefir: Aim for 4-8 ounces daily to support gut health.
- Rice Congee: A soupy rice mixture that is easy to digest. Combine 1 cup long or short-grain white rice with 6-7 cups of water and one teaspoon of salt; bring to a boil, then simmer until you have a sticky, soupy mixture (usually ~ 40 minutes).
- Apple or grape juice
- Applesauce, peeled apples, and bananas
- Eggs, buttermilk, and yogurt
- Fish, poultry, and meat that has been broiled or roasted
- Mild, cooked vegetables, such as asparagus tips, green or black beans, carrots, spinach, and squash
- Potatoes that have been baked, boiled, or mashed
- Processed cheeses, such as American cheese
- Smooth peanut butter
- White bread, macaroni, or noodles
Temperature
Eat foods at room temperature to minimize irritation.
Read also: The Hoxsey Diet
Additional Nutritional Considerations
Vitamin and Mineral Supplementation
Malabsorption due to diarrhea can lead to vitamin and mineral deficiencies. Consult with a dietitian to determine if a supplement is needed. A chewable product with 100% of the daily value (DV) for most vitamins and minerals can be taken twice daily. Blood tests for vitamin B12 and fat-soluble vitamins may also be necessary.
Gluten Intolerance
Consider testing for undiagnosed celiac disease (gluten intolerance). If diagnosed, a 100% gluten-free diet is required to manage the condition.
Complementary and Alternative Therapies
Review all complementary and alternative therapies, such as special teas, vitamins, minerals, herbal supplements, and other nutrients, with an RDN.
Medical Treatments
In addition to dietary modifications, medical treatments may be necessary:
- Diarrhea Medications: Discuss diarrhea medication options with a doctor.
- Antibiotics: Inflammation caused by radiation may lead to bacterial overgrowth in the small intestine.
The Role of Probiotics and Prebiotics
Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Prebiotics are nondigestible carbohydrates that enhance the proliferation and/or metabolic activities of the beneficial intestinal microbiota.
Probiotics
The use of probiotics during pelvic radiotherapy has demonstrated a decrease in the mean number of bowel movements and a decrease in the incidence of diarrhea. Probiotics can help repopulate the gut microbiota, potentially preventing or repairing intestinal damage.
Prebiotics
Prebiotics, such as soluble fibers and inulin-like fructans, can help correct imbalances in the gut bacterial environment, reducing inflammation and stimulating healing.
Nutritional Support
Inflammation in the small intestine can reduce the body's ability to absorb nutrients. Nutritional support may be necessary to address malabsorption.
Enteral and Parenteral Nutrition
In severe cases, enteral (tube feeding) or parenteral (intravenous) nutrition may be required to ensure adequate nutrient intake.
Surgical Intervention
In rare cases, surgery may be needed to remove the affected intestine or to construct a way for waste to avoid that section.
Lifestyle Adjustments
In addition to diet, several lifestyle adjustments can help manage radiation enteritis:
- Stay Hydrated: Drink plenty of fluids, up to 12 eight-ounce (240 milliliter) glasses every day when you have diarrhea.
- Avoid Irritants: Limit or avoid alcohol, tobacco, and caffeine.
- Eat at Room Temperature: Serve foods at room temperature to minimize irritation.
Questions to Ask Your Provider
- What symptoms or problems should I call you about?
- What medicines can I take for diarrhea and other radiation enteritis symptoms?
- What liquids and foods should I have each day?
tags: #radiation #enteritis #diet #recommendations