RADIATION-INDUCED GASTROINTESTINAL TOXICITY - PATHOPHYSIOLOGY, APPROACHES TO TREATMENT AND PROPHYLAXIS

Background: Gastrointestinal toxicity is frequently observed during ra diotherapy of malignancies in the abdomen and pelvis. The proposed pat hophysiology of radiation enteritis is complex and a variety of differ ent treatment strategies have been suggested for the management of acu te radiation-induced diarrhea. Material and Methods: Data are presente d from an extensive review of the current literature. Results: Radiati on-induced diarrhea results from a variety of different pathophysiolog ical mechanisms including malabsorption of bile salts and lactose, imb alances in local bacterial flora and changes in the intestinal pattern s of motility up to date acute radiation diarrhea is predominantly tre ated symptomatically using opioide derivates (loperamide) or adsorbant s of bile salts such as smectite. Clinical trials have been performed using L. acidophilus, smectite or sucralfate for diarrhea prophylaxis with moderate reduction of acute symptoms. Conclusions: Further evalua tion of strategies for diarrhea prophylaxis is warranted. Due to the c omplex nature of radiation enteritis a multimodal approach taking into account alterations in intestinal motility patterns, malabsorption of bile salts and an imbalance of mucosal bacterial flora may offer new perspectives.