Andreyev, H.J.N.; Amin, Z.; Blake, P.; Dearnaley, D.; Tait, D.; Vlavianos, P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA90
Academic Journal
Background: After pelvic radiotherapy, at least 30% patients develop permanent change in bowel habit affecting quality of life. Most are never referred to a gastroenterologist. Aim and Methods: To analyse the cause for Gl symptoms following pelvic radiotherapy we prospectively recorded all final diagnoses from a consecutive series of patients with symptoms starting at any time after their treatment referred over 24 months to a gastroenterology clinic. Results: 167 patients have completed investigations. 51 women, median age 62 (22-81 years), 116 men, median age 70 (31-85 years). Radiotherapy ended 2.5 years (0-13) earlier in women and 2 years (0-21) in men. Primary tumours were urological (n = 117), gynaecological (n = 43), and gastrointestinal (n = 9). Reasons for referral included: rectal bleeding (n = 109), loose stool or incontinence (n = 69), tenesmus or discomfort (n = 33), change in habit (n = 18), vomiting (n = 13), or other (n = 4). After investigation, diagnoses could be grouped into 3 categories, definitely related, possibly related or clearly unrelated to previous radiotherapy. Diagnoses directly related included proctitis (n = 92), sigmoid ulceration (n = 2), and obstruction (n = 4). Findings possibly related included hyperplastic polyposis (n = 13), bacterial overgrowth (n = 7), squamous polyps (n = 3), fatty acid malabsorption (n = 2), pancreatic insufficiency (n = 2), bile salt malabsorption, collagenous colitis, and relapsed ulcerative colitis (n = 1 each). Diagnoses unrelated to radiotherapy included a new primary tumour (n = 6), relapse of the primary cancer (n = 7), adenomatous polyps (n = 19), diverticular disease (n = 37), hypothyroidism (n = 2), infection (n = 2), irritable bowel syndrome (n = 2), alcohol (n = 2), rectal mucosal prolapse, and bleeding piles (n = 1 each). In 2 patients, no diagnosis was made. Gastroenterological referral changed the diagnosis in 64% and allowed institution of curative therapy in 27%. Conclusion:...


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