1. Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre
- Author
-
Ramya Kalaiselvan, I.D. Anderson, Martyn Dibb, Gordon L Carlson, Simon Lal, Antje Teubner, V S Theis, and Jonathan Shaffer
- Subjects
Adult ,Male ,Short Bowel Syndrome ,medicine.medical_specialty ,Pediatrics ,Referral ,Medicine (miscellaneous) ,Enteral administration ,Intestinal Fistula ,medicine ,Radiation Enteritis ,Humans ,Medical nutrition therapy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Nutrition and Dietetics ,Radiotherapy ,business.industry ,Retrospective cohort study ,Middle Aged ,Short bowel syndrome ,medicine.disease ,Enteritis ,United Kingdom ,Surgery ,Intestinal Diseases ,Treatment Outcome ,Parenteral nutrition ,Cohort ,Female ,Nutrition Therapy ,Parenteral Nutrition, Home ,business ,Intestinal Obstruction ,Urogenital Neoplasms - Abstract
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. 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). 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%. 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.
- Published
- 2013