SEVERE LATE RADIATION ENTEROPATHY IS CHARACTERIZED BY IMPAIRED MOTILITY OF PROXIMAL SMALL-INTESTINE

Late radiation enteropathy (LRE) is a serious disorder, and therapeuti c progress has thus far been hampered by insufficient understanding of the pathogenesis. This prospective study addresses whether alteration s in proximal intestinal motility can predict the clinical severity of this disorder. Forty-one consecutive patients with chronic abdominal complaints after radiotherapy for gynecological cancer were examined b y prolonged ambulatory manometry. Twenty-seven healthy adults served a s controls. Impaired fasting motility was found in 12 of 41 patients ( 29%), and attenuated postprandial motor response after a liquid-solid meal was seen in 10 of 41 patients (24%). Postprandial delay of the mi grating motor complex (MMC) was a good predictor of the degree of maln utrition (Cox regression, P < 0.01), and intensity of the MMC and post prandial motility index explained 69% (P < 0.001, multiple regression) of the variability in degree of malnutrition, assessed by weight loss and serum albumin level. The typical presentation of severe LRE was c linical symptoms suggesting intestinal pseudoobstruction, malnutrition , failure of a liquid-solid meal to induce postprandial motility, and delayed initiation and reduced intensity of MMC during nocturnal fasti ng. Prolonged ambulatory manometry was useful for detection of dysmoti lity in patients with symptoms of LRE and impaired motility of proxima l small intestine seems to be a key factor in the pathogenesis of seve re LRE.