Overview of Radiotherapy
Radiation therapy, referred to as radiotherapy, is widely used in the management of malignant tumors of the thoracic mediastinum, but due to the ionizing effect of radiation on living organisms, it can also cause normal tissues and cells to suffer damage and destruction. The squamous epithelium of the esophagus is sensitive to radioactive substances, therefore, there is a possibility of radiation esophageal injury in the course of radiotherapy, especially when radiotherapy and chemotherapy are carried out at the same time, this esophageal injury will be more serious. This type of radiation-induced esophageal injury is called radiation esophagitis.
Causes
Radiation therapy (radiation) ionizes living organisms and causes a series of pathophysiological reactions that destroy and damage tissue cells. Radiation esophagitis often occurs during or after radiotherapy for lung cancer and thoracic malignant tumors such as mediastinum, and sometimes indirectly for malignant tumors of the oropharynx. Radiotherapy dose of 30Gy can cause neuromuscular damage to the esophagus, resulting in weakened peristalsis or even disappearance of the esophagus. As the radiation dose increases, the esophageal damage becomes more serious. The ionization effect of radiation itself can cause damage and necrosis of esophageal epithelial cells. On this basis, due to the slowing down of esophageal peristalsis, causing harmful substances to pass through the esophagus for a prolonged period of time, aggravating this damage. In addition, radiotherapy can cause a decrease in the body’s white blood cells and a reduction in the body’s immunity, which can lead to esophageal infections and esophagitis.
Symptoms
Symptoms such as nausea, vomiting, chest pain, fever, and fatigue occur within minutes in 50% to 70% of patients who receive radiation and are referred to as the prodrome syndrome. Typical symptoms of esophagitis are pain under the throat or pain behind the sternum. It commonly occurs 1 week or several weeks after radiation therapy and is usually mild. In severe cases, severe chest pain, fever, choking, dyspnea, vomiting, vomiting blood, etc., should be vigilant for the occurrence of esophageal perforation or esophagotracheal fistula.
Examination
1. Laboratory examination
Routine laboratory tests with diagnostic significance are decreased blood leukocyte count.
2. Other auxiliary tests
(1) In early symptomatic cases, a barium swallow of the esophagus may show a weakened peristaltic wave and esophageal ulcers, while esophageal stenosis may be seen in advanced cases.
(2) Esophagoscopy can reveal the manifestations of esophagitis in different periods.
Diagnosis
Diagnosis can be made based on the history and clinical features, combined with relevant examinations.
Differential diagnosis
1. Purulent esophagitis
Mechanical injury caused by foreign body is the most common. Bacteria multiply in the esophageal wall, causing localized inflammatory exudation, tissue necrosis of varying degrees and pus formation, or more extensive cellulitis.
2. Esophageal tuberculosis
Patients usually have the precursor symptoms of tuberculosis of other organs, especially tuberculosis of the lungs. The symptoms of esophagus itself are often confused or masked by the symptoms of other organs, so that they cannot be detected in time. According to the pathological process of tuberculosis, there may be symptoms of toxicity such as fatigue, low fever and rapid increase of blood sedimentation in the early stage of infiltration progression, but there are also people with inconspicuous symptoms. This is followed by dysphagia and progressive dysphagia, often accompanied by persistent pharyngeal and retrosternal pain, which is aggravated by swallowing. Lesions of the ulcerative type are mostly characterized by pain on swallowing. Food spillage into the trachea should be considered for tracheoesophageal fistula formation. Dysphagia suggests a scarring stenosis due to fibrosis of the lesion.
3. Fungal esophagitis
Clinical symptoms are atypical, and some patients may not have any clinical symptoms. Common symptoms are swallowing pain, dysphagia, epigastric discomfort, retrosternal pain and burning sensation. In severe cases, the retrosternal pain is cut-like colic, which may radiate to the back like angina pectoris. Severe bleeding can occur in Candida esophagitis but is uncommon. Untreated patients may have epithelial detachment, perforation or even disseminated candidiasis. Perforation of the esophagus may cause mediastinitis, esophagotracheal fistula and esophageal stricture. Patients with granulocytopenia who have persistent high fever should be examined for disseminated acute candidiasis of the skin, liver, spleen and lungs.
4. Viral esophagitis
HBV infection of the esophagus is often accompanied by herpes nasolabialis. The main symptom is painful swallowing. The pain is often exacerbated when swallowing food, and food travels slowly down the esophagus after swallowing. Dysphagia is the main symptom in a minority of patients and may be asymptomatic in mild infections.
Complications
If the patient has persistent severe pain behind the sternum, accompanied by fever, rapid pulse, etc., esophageal perforation should be guarded against, and further examination and appropriate treatment should be done immediately. Esophageal perforation, hemorrhage and fistula after radiotherapy in patients with esophageal cancer are not all caused by radiation esophagitis, but may be caused by necrosis of tumor tissue after radiotherapy.
Treatment
1. Relieve spasm of esophageal smooth muscle and protect esophageal mucosa.
(1) Nifedipine (cardioplegia), half an hour before meals.
(2) Isosorbide nitrate (cardiac pain relief), half an hour before meals.
(3) Thioglycollate aluminum and other mucosal protective agents, half an hour before meals.
2. Inhibit gastric acid and prevent acid reflux into the esophagus.
(1) H2 receptor blocking drugs such as ranitidine, half an hour before meals.
(2) Proton pump inhibitors, such as omeprazole, half an hour before meals.
3. Symptomatic treatment
Stop vomiting, stop bleeding, sedation, prevent infection. High-calorie, high-protein, high-vitamin and easy-to-digest diet should be given. Suspected perforation requires fasting, fluid infusion and anti-infection.
4. Corticosteroid
Adrenocortical failure can be caused by massive irradiation treatment. The application of corticosteroid can reduce the radiation damage and improve the course of the disease. However, antibiotics should be used at the same time to prevent infection. The use of prednisone (prednisone), oral appropriate.
5. Enhance cellular immunity.
6. Other
In addition to the above treatments, suspend irradiation or prolong the interval between treatments if necessary.
Questions you may be concerned about
Can radioactive esophagitis drink Rehabilitation New Liquid?
Patients with radiation esophagitis can take Rehabilitation New Liquid with some effect, which can properly promote mucosal repair and reduce symptoms; however, Rehabilitation New Liquid is not used as a regular medication for the treatment of radiation esophagitis.
1. Radiation esophagitis is a malignant tumor in the chest in the process of radiotherapy, making the esophageal epithelium inflammatory damage, resulting in a series of uncomfortable symptoms.
2. Rehabilitation new liquid has the effect of promoting blood circulation, nourishing yin and generating muscle, when the esophageal mucosa is obviously damaged, especially when there is local congestion and edema or even punctiform erosion, taking rehabilitation new liquid has the effect of promoting the repair of the mucosa and alleviating the symptoms, and to a certain extent, it can alleviate the symptoms of radiation esophagitis. However, Rehabilitation New Liquid is not a regular medication for the treatment of radiation esophagitis.
When using Rejuvenate Liquid for treatment, one must consult a medical professional for advice and should not use the drug blindly; if the symptoms do not improve after taking the drug, one should consult a medical doctor in time.
Prevention
1. Acid suppressants, H2 receptor antagonists, surface anesthetics, esophageal dynamics, etc. can be used to relieve the symptoms of acute radiation esophagitis. At the same time, according to the severity of the disease, sedation, antiemetic, hemostatic and anti-infective treatments are given. Dietary choices should be high-calorie, high-protein, high-vitamin and easy-to-digest diet.
2. It is believed that patients receiving high-dose radiotherapy may have attenuation of adrenocortical function. Therefore, the use of glucocorticoids may be considered in patients with radiation esophagitis to reduce radiation damage as well as to improve the course of the disease.