Zimmerer T, Böcker U, Wenz F, Singer M V
Department of Medicine II, University Hospital Mannheim.
Z Gastroenterol. 2008 May;46(5):441-8. doi: 10.1055/s-2008-1027150.
Radiation enteritis is a severe problem in patients receiving irradiation of the abdomen or pelvis in the course of cancer treatment. Nevertheless, there is a lack of standardised strategies for medical prevention and therapy.
A PubMed based literature search was performed to address the available data on the prevention of and therapy for acute and chronic radiation enteritis.
Four double-blind and placebo-controlled studies used 5-aminosalycilates in the prevention of acute radiation enteritis. Only for sulphasalzine 2 g/d was a positive effect proven. Prophylactic administration of probiotics reduced the incidence of acute radiation enteritis in a large placebo-controlled trial. If acute radiation enteritis was present octreotide ameliorated radiation-induced diarrhoea in a randomised study. Two investigations, only one of them randomised, described the effectiveness of loperamide in the treatment of acute radiation enteritis. If diarrhoea was also the main symptom of chronic radiation enteritis, loperamide reduced stool frequency in a double-blind and placebo-controlled study. A retrospective analysis of severe cases of chronic radiation enteritis with obstruction and fistula indicated that parenteral nutrition at home was more effective than surgery.
Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-beta, for example, might be a new promising therapy approach.
放射性肠炎是癌症治疗过程中接受腹部或盆腔照射患者面临的一个严重问题。然而，目前缺乏标准化的医学预防和治疗策略。
通过在PubMed上进行文献检索，以获取有关急性和慢性放射性肠炎预防与治疗的现有数据。
四项双盲安慰剂对照研究使用5-氨基水杨酸预防急性放射性肠炎。仅证明柳氮磺胺吡啶2g/d有积极效果。在一项大型安慰剂对照试验中，预防性使用益生菌可降低急性放射性肠炎的发生率。在一项随机研究中，若出现急性放射性肠炎，奥曲肽可改善辐射引起的腹泻。两项研究（其中只有一项是随机的）描述了洛哌丁胺治疗急性放射性肠炎的有效性。若腹泻也是慢性放射性肠炎的主要症状，在一项双盲安慰剂对照研究中，洛哌丁胺可减少排便次数。一项对伴有梗阻和瘘管的慢性放射性肠炎重症病例的回顾性分析表明，家庭肠外营养比手术更有效。
降低辐射剂量和缩小照射野仍然是预防急性和慢性放射性肠炎的最重要因素。尤其缺乏关于慢性放射性肠炎治疗的有效数据。更好地理解病理生理学，特别是在慢性放射性肠炎方面，可能会带来新的治疗前景。例如，抑制转化生长因子-β可能是一种新的有前景的治疗方法。
