Advances in clinical diagnosis and treatment of radiation enteritis

doi:10.3760/cma.j.cn371439-20220930-00005

Abstract

Abstract:

Small bowel capsule endoscopy and double-balloon enteroscopy have become new methods for clinical diagnosis of radiation enteritis （RE）， especially for abnormal intestinal tissue. Targeted biopsy or interventional therapy is expected to achieve precision treatment of RE. The screening of molecular markers in biological samples has also become a new direction for RE diagnosis. Fecal microbiota transplantation has become one of the promising treatments for RE. In addition， mechanism studies based on traditional Chinese medicine， targeted cell death， and omics analysis provide rich strategies for the diagnosis and treatment of RE.

Key words: Pelvic neoplasms, Gastrointestinal diseases, Radiation enteritis

Ma Chenying, Zhao Jing, Xu Xiaoting, Qin Songbing, Zhou Juying. Advances in clinical diagnosis and treatment of radiation enteritis[J]. Journal of International Oncology, 2023, 50(1): 28-32.

References 39

[1]	Andreyev HJ, Wotherspoon A, Denham JW, et al. "Pelvic radiation disease": new understanding and new solutions for a new disease in the era of cancer survivorship[J]. Scand J Gastroenterol, 2011, 46(4): 389-397. DOI: 10.3109/00365521.2010.545832. doi: 10.3109/00365521.2010.545832
[2]	Shadad AK, Sullivan FJ, Martin JD, et al. Gastrointestinal radiation injury: symptoms, risk factors and mechanisms[J]. World J Gastroenterol, 2013, 19(2): 185-198. DOI: 10.3748/wjg.v19.i2.185. doi: 10.3748/wjg.v19.i2.185
[3]	中国医师协会外科医师分会, 中华医学会外科学分会结直肠外科学组. 中国放射性直肠炎诊治专家共识(2018版)[J]. 中华炎性肠病杂志, 2019, 3(1): 5-20. DOI: 10.3760/cma.j.issn.2096-367X.2019.01.003. doi: 10.3760/cma.j.issn.2096-367X.2019.01.003
[4]	Gandle C, Dhingra S, Agarwal S. Radiation-induced enteritis[J]. Clin Gastroenterol Hepatol, 2018, 18(3): A39-A40. DOI: 10.1016/j.cgh.2018.11.060. doi: 10.1016/j.cgh.2018.11.060
[5]	Son JH, Kim SH, Cho EY, et al. Comparison of diagnostic performance between 1 millisievert CT enterography and half-standard dose CT enterography for evaluating active inflammation in patients with Crohn's disease[J]. Abdom Radiol (NY), 2018, 43(7): 1558-1566. DOI: 10.1007/s00261-017-1359-1. doi: 10.1007/s00261-017-1359-1 pmid: 29038856
[6]	Loge L, Florescu C, Alves A, et al. Radiation enteritis: diagnostic and therapeutic issues[J]. J Visc Surg, 2020, 157(6): 475-485. DOI: 10.1016/j.jviscsurg.2020.08.012. doi: 10.1016/j.jviscsurg.2020.08.012 pmid: 32883650
[7]	Gatti M, Allois L, Carisio A, et al. Magnetic resonance enterography[J]. Minerva Gastroenterol Dietol, 2019, 65(4): 319-334. DOI: 10.23736/S1121-421X.19.02639-4. doi: 10.23736/S1121-421X.19.02639-4 pmid: 31760740
[8]	Schofield JB, Haboubi N. Histopathological mimics of inflammatory bowel disease[J]. Inflamm Bowel Dis, 2020, 26(7): 994-1009. DOI: 10.1093/ibd/izz232. doi: 10.1093/ibd/izz232 pmid: 31599934
[9]	Baumgartner M, Lang M, Holley H, et al. Mucosal biofilms are an endoscopic feature of irritable bowel syndrome and ulcerative colitis[J]. Gastroenterology, 2021, 161(4): 1245-1256.e20. DOI: 10.1053/j.gastro.2021.06.024. doi: 10.1053/j.gastro.2021.06.024 pmid: 34146566
[10]	Ben-Horin S, Lahat A, Amitai MM, et al. Assessment of small bowel mucosal healing by video capsule endoscopy for the prediction of short-term and long-term risk of Crohn's disease flare: a prospective cohort study[J]. Lancet Gastroenterol Hepatol, 2019, 4(7): 519-528. DOI: 10.1016/S2468-1253(19)30088-3. doi: 10.1016/S2468-1253(19)30088-3
[11]	Rai M, Hookey L, Bechara R. A case of radiation-induced enteritis diagnosed by video capsule endoscopy[J]. Gastrointest Endosc, 2019, 90(2): 315-316. DOI: 10.1016/j.gie.2019.03.027. doi: S0016-5107(19)30218-4 pmid: 30935933
[12]	Omori T, Kambayashi H, Murasugi S, et al. Evaluation of intestinal patency with the patency capsule: the twenty-four hour assessment method[J]. Digestion, 2019, 100(3): 176-185. DOI: 10.1159/000494717. doi: 10.1159/000494717 pmid: 30463059
[13]	Lu W, Xie Y, Huang B, et al. Platelet-derived growth factor C signaling is a potential therapeutic target for radiation proctopathy[J]. Sci Transl Med, 2021, 13(582): eabc2344. DOI: 10.1126/scitranslmed.abc2344. doi: 10.1126/scitranslmed.abc2344
[14]	Hille A, Schmidt-Giese E, Hermann RM, et al. A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment[J]. Scand J Gastroenterol, 2008, 43(1): 52-58. DOI: 10.1080/00365520701579985. doi: 10.1080/00365520701579985
[15]	Wang JW, Kuo CH, Kuo FC, et al. Fecal microbiota transplantation: review and update[J]. J Formos Med Assoc, 2019, 118 Suppl 1: S23-S31. DOI: 10.1016/j.jfma.2018.08.011. doi: 10.1016/j.jfma.2018.08.011
[16]	Ding X, Li Q, Li P, et al. Fecal microbiota transplantation: a promising treatment for radiation enteritis?[J]. Radiother Oncol, 2020, 143: 12-18. DOI: 10.1016/j.radonc.2020.01.011. doi: S0167-8140(20)30023-2 pmid: 32044171
[17]	Cui M, Xiao H, Li Y, et al. Faecal microbiota transplantation protects against radiation-induced toxicity[J]. EMBO Mol Med, 2017, 9(4): 448-461. DOI: 10.15252/emmm.201606932. doi: 10.15252/emmm.201606932 pmid: 28242755
[18]	Xiao HW, Cui M, Li Y, et al. Gut microbiota-derived indole 3-propionic acid protects against radiation toxicity via retaining acyl-CoA-binding protein[J]. Microbiome, 2020, 8(1): 69. DOI: 10.1186/s40168-020-00845-6. doi: 10.1186/s40168-020-00845-6
[19]	Jang H, Lee J, Park S, et al. Baicalein mitigates radiation-induced enteritis by improving endothelial dysfunction[J]. Front Pharmacol, 2019, 10: 892. DOI: 10.3389/fphar.2019.00892. doi: 10.3389/fphar.2019.00892 pmid: 31474856
[20]	Ito I, Loucas BD, Suzuki S, et al. Glycyrrhizin protects γ-irradiated mice from gut bacteria-associated infectious complications by improving miR-222-associated Gas5 RNA reduction in macrophages of the bacterial translocation site[J]. J Immunol, 2020, 204(5): 1255-1262. DOI: 10.4049/jimmunol.1900949. doi: 10.4049/jimmunol.1900949
[21]	Hou Q, Liu L, Dong Y, et al. Effects of thymoquinone on radiation enteritis in mice[J]. Sci Rep, 2018, 8(1): 15122. DOI: 10.1038/s41598-018-33214-3. doi: 10.1038/s41598-018-33214-3 pmid: 30310156
[22]	Tiwari M, Dixit B, Parvez S, et al. EGCG, a tea polyphenol, as a potential mitigator of hematopoietic radiation injury in mice[J]. Biomed Pharmacother, 2017, 88: 203-209. DOI: 10.1016/j.biopha.2016.12.129. doi: S0753-3322(16)32669-5 pmid: 28107697
[23]	Zhang J, Pang Z, Zhang Y, et al. Genistein from Fructus sophorae protects mice from radiation-induced intestinal injury[J]. Front Pharmacol, 2021, 12: 655652. DOI: 10.3389/fphar.2021.655652. doi: 10.3389/fphar.2021.655652
[24]	Wang M, Dong Y, Wu J, et al. Baicalein ameliorates ionizing radiation-induced injuries by rebalancing gut microbiota and inhibiting apoptosis[J]. Life Sci, 2020, 261: 118463. DOI: 10.1016/j.lfs.2020.118463. doi: 10.1016/j.lfs.2020.118463
[25]	Kim HG, Jang SS, Lee JS, et al. Panax ginseng Meyer prevents radiation-induced liver injury via modulation of oxidative stress and apoptosis[J]. J Ginseng Res, 2017, 41(2): 159-168. DOI: 10.1016/j.jgr.2016.02.006. doi: 10.1016/j.jgr.2016.02.006
[26]	Cagin YF, Parlakpinar H, Vardi N, et al. Protective effects of apocynin against ionizing radiation-induced hepatotoxicity in rats[J]. Biotech Histochem, 2022, 97(3): 228-235. DOI: 10.1080/10520295.2021.1936641. doi: 10.1080/10520295.2021.1936641
[27]	陈代词, 钟清华, 陈锶. 放射性肠损伤血管病变基础及其诊疗进展[J]. 中华胃肠外科杂志, 2020, 23(8): 817-822. DOI: 10.3760/cma.j.cn.441530-20200511-00270. doi: 10.3760/cma.j.cn.441530-20200511-00270
[28]	Xu C, Liu Z, Xiao J. Ferroptosis: a double-edged sword in gastrointestinal disease[J]. Int J Mol Sci, 2021, 22(22): 12403. DOI: 10.3390/ijms222212403. doi: 10.3390/ijms222212403
[29]	Wang JT, Xie WQ, Liu FQ, et al. NADH protect against radiation enteritis by enhancing autophagy and inhibiting inflammation through PI3K/AKT pathway[J]. Am J Transl Res, 2018, 10(6): 1713-1721.
[30]	Dar HH, Epperly MW, Tyurin VA, et al. P. aeruginosa augments irradiation injury via 15-lipoxygenase-catalyzed generation of 15-HpETE-PE and induction of theft-ferroptosis[J]. JCI Insight, 2022, 7(4): e156013. DOI: 10.1172/jci.insight.156013. doi: 10.1172/jci.insight.156013
[31]	Xu Y, Tu W, Sun D, et al. Nrf2 alleviates radiation-induced rectal injury by inhibiting of necroptosis[J]. Biochem Biophys Res Commun, 2021, 554: 49-55. DOI: 10.1016/j.bbrc.2021.03.004. doi: 10.1016/j.bbrc.2021.03.004
[32]	Liu L, Liang L, Yang C, et al. Extracellular vesicles of Fusobacterium nucleatum compromise intestinal barrier through targeting RIPK1-mediated cell death pathway[J]. Gut Microbes, 2021, 13(1): 1-20. DOI: 10.1080/19490976.2021.1902718. doi: 10.1080/19490976.2021.1902718
[33]	安江宏, 钱莘, 骆璞, 等. 肠道微生态与肿瘤的诊断和治疗[J]. 国际肿瘤学杂志, 2021, 48(7): 436-440. DOI: 10.3760/cma.j.cn371439-20201019-00084. doi: 10.3760/cma.j.cn371439-20201019-00084
[34]	Wang Z, Wang Q, Wang X, et al. Gut microbial dysbiosis is associated with development and progression of radiation enteritis during pelvic radiotherapy[J]. J Cell Mol Med, 2019, 23(5): 3747-3756. DOI: 10.1111/jcmm.14289. doi: 10.1111/jcmm.14289 pmid: 30908851
[35]	Guo H, Chou WC, Lai Y, et al. Multi-omics analyses of radiation survivors identify radioprotective microbes and metabolites[J]. Science, 2020, 370(6516): eaay9097. DOI: 10.1126/science.aay9097. doi: 10.1126/science.aay9097
[36]	Li Y, Yan H, Zhang Y, et al. Alterations of the gut microbiome composition and lipid metabolic profile in radiation enteritis[J]. Front Cell Infect Microbiol, 2020, 10: 541178. DOI: 10.3389/fcimb.2020.541178. doi: 10.3389/fcimb.2020.541178
[37]	Song S, Chen D, Ma T, et al. Molecular mechanism of acute radiation enteritis revealed using proteomics and biological signaling network analysis in rats[J]. Dig Dis Sci, 2014, 59(11): 2704-2713. DOI: 10.1007/s10620-014-3224-1. doi: 10.1007/s10620-014-3224-1
[38]	Yang C, Yang J, Xia M, et al. Efficacy of compound herbal medicine Tong-Xie-Yao-Fang for acute radiation enteritis and its potential mechanisms: evidence from transcriptome analysis[J]. Biomed Res Int, 2020, 2020: 5481653. DOI: 10.1155/2020/5481653. doi: 10.1155/2020/5481653
[39]	Bodalal Z, Trebeschi S, Nguyen-Kim TDL, et al. Radiogenomics: bridging imaging and genomics[J]. Abdom Radiol (NY), 2019, 44(6): 1960-1984. DOI: 10.1007/s00261-019-02028-w. doi: 10.1007/s00261-019-02028-w pmid: 31049614