Acute Radiation Gastro-Intestinal syndrome

Dmitri Popov. PhD, Radiobiology. MD (Russia)

Advanced Medical Technology and Systems Inc. Canada.

Acute Radiation Gastro-Intestinal

Syndrome.

Acute Gastro-Intestinal Radiation Syndrome.






Acute Gastro-Intestinal Radiation

Syndrome.

Grading System for Acute Gastro - Intestinal

Radiation Syndrome based on general clinical

signs .

Degree 1 – Mild GI ARS.

Radiation GI Neurotoxins - SRD – 3.1. – Group.

Nausea, Vomiting - Occasional (once per day).

Anorexia - Able to eat , appetite decreased.

Fatigue syndrome - Able to work.

Hypotension - Blood pressure>100/70 mm Hg.


Syndrome.

Colon Epithelium deficit – increased apoptosis,

focal necroptosis. Inflammation detectable, but

not significant.

Blood loss - Detectable, minor.

Degree 2 of GI ARS - Moderate degree.

Group of Radiation Neurotoxins SRD – 3.2.

Nausea, Vomiting – Intermitted (2-5 times per

day).

Anorexia. Intake decreased.


Syndrome.

Fatigue syndrome: Impaired work ability.

Hypotension: Blood pressure <100/70 mmHg.

Colon Epithelium deficit: Easy detectable. Increased apoptosis, significant necroptosis.

Blood loss - Moderate loss.

Degree 3 – Severe degree of GI ARS.

Radiation GI Neurotoxins: SRD – 3.3 Group.

Nausea, Vomiting - Persistent (6-10 times per day). Bloody diarrhea. Need assistance in activity of daily living.


Syndrome.

Anorexia: Intake minimal, Parenteral nutrition.

Hypotension - Blood pressure <90/60 mm Hg.

Need blood components transfusion.

Major blood loss. Life treating.

Colon Epithelium deficit – significant damage,

inflammation, necroptosis, some or significant

ulceration with colon wall damage.


Syndrome.

Degree 4 – Extremely severe Grade of GI ARS.

Radiation GI Neurotoxins: SRD – 3.1.

Nausea, Vomiting: Extremely severe

Refractory (>10 times per day)

Anorexia: Parenteral nutrition.

Fatigue syndrome: Severe fatique.


Syndrome.

Hypotension: Blood pressure <80/? Mm Hg;

Heart beat cessation. Life threatening,

Colon Epithelium deficit: Prominent loss of colon

function with deep colon wall damage, epithelium

necroptosis, necrosis, severe form of ulceration.

Possible perforation, function cessation.

Major bleeding from GI tract.









Gastrointestinal (GI) syndrome: the Acute

Gastrointestinal syndrome occur with a dose

greater than approximately 10 Gy (1000 rads)

although some symptoms may occur as low as 6

Gy or 600 rads.

Survival rate depend on severity of GI - ARS.

Destructive and irreparable changes in the GI tract

usually cause infection, dehydration, and electrolyte

imbalance. Death usually occurs within 2 weeks.


Gastrointestinal (GI) ARS usually develop

together with Hematopoietic ARS.

Gastrointestinal (GI) - Symptoms are anorexia,

severe nausea, vomiting, cramps, and diarrhea.

• Onset occurs within a few hours after exposure.

• Stage lasts about 2 days.

Hematopoietic ARS - Symptoms are anorexia,

nausea and vomiting.

• Onset occurs 1 hour to 2 days after exposure.

• Stage lasts for minutes to days.


Hematopoetic ARS (developing together with GI

ARS)

• Stem cells in bone marrow are dying, although

patient may appear and feel well.

• Stage lasts 1 to 6 weeks.

GI ARS - Stem cells in bone marrow and cells

lining GI tract are dying, although patient may

appear and feel well. Stage lasts less than 1

week.


Hematopoietic ARS - Symptoms are anorexia,

fever, and malaise. Drop in all blood cell counts

occurs for several weeks.

Primary cause of death is infection and

hemorrhage. Developing in together with GI –

ARS.


GI - ARS Symptoms are malaise, anorexia,

severe diarrhea, fever, dehydration, and

electrolyte imbalance + symptoms of

Hematopoietic ARS.

Death is due to infection, dehydration, and

electrolyte imbalance.

Death occurs within 2 weeks of exposure.

The extent of colonic mucosal involvement and

severity of disease correlate with the clinical

manifestations of ulcerative radiation colitis.


Mild Grade of Gastro- Intestinal ARS.

Death in 10 - 15 days


Moderate Grade of Gastro- Intestinal ARS.

Death in 5-7 days


Severe Grade of Gastro- Intestinal ARS.

Death in 2 - 3 days.


Extremely Severe Grade of Gastro-Intestinal

ARS.

Death in 24 hours.

Health & Medicine

Acute Radiation Gastro-Intestinal syndrome