Classen J, Belka C, Paulsen F, Budach W, Hoffmann W, Bamberg M
Abteilung für Strahlentherapie der Universität Tübingen.
Strahlenther Onkol. 1998 Nov;174 Suppl 3:82-4.
Gastrointestinal toxicity is frequently observed during radiotherapy of malignancies in the abdomen and pelvis. The proposed pathophysiology of radiation enteritis is complex and a variety of different treatment strategies have been suggested for the management of acute radiation-induced diarrhea.
Data are presented from an extensive review of the current literature.
Radiation-induced diarrhea results from a variety of different pathophysiological mechanisms including malabsorption of bile salts and lactose, imbalances in local bacterial flora and changes in the intestinal patterns of motility. Up to date acute radiation diarrhea is predominantly treated symptomatically using opioide derivates (loperamide) or adsorbants 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.
Further evaluation of strategies for diarrhea prophylaxis is warranted. Due to the complex 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.
腹部和盆腔恶性肿瘤放疗期间经常观察到胃肠道毒性。放射性肠炎的病理生理学机制复杂，针对急性放射性腹泻的治疗已提出了多种不同的策略。
本文数据来自对当前文献的广泛综述。
放射性腹泻由多种不同的病理生理机制引起，包括胆盐和乳糖吸收不良、局部细菌菌群失衡以及肠道运动模式改变。目前，急性放射性腹泻主要采用阿片类衍生物（洛哌丁胺）或胆盐吸附剂（如蒙脱石）进行对症治疗。使用嗜酸乳杆菌、蒙脱石或硫糖铝预防腹泻的临床试验已开展，急性症状有一定程度减轻。
有必要进一步评估腹泻预防策略。鉴于放射性肠炎的复杂性，考虑到肠道运动模式改变、胆盐吸收不良和黏膜细菌菌群失衡的多模式方法可能会带来新的前景。
