What is Radiation Esophagitis?
Radiation esophagitis is a condition where the esophagus, the tube that connects your throat to your stomach, becomes irritated as a result of radiation treatments. Essentially, this is a side effect that individuals may experience after receiving radiation therapy to treat cancers like breast cancer, lung cancer, or other lymphoma.
Patients often begin to feel symptoms two to three weeks after starting their treatment. These symptoms can include throat pain, difficulty swallowing, and feeling as if food is stuck in their throat. A medication called Amifostine, which is usually given through an injection half an hour before the radiation therapy, has shown promise in reducing the chances of developing radiation esophagitis in certain patient groups.
The main focus when treating this condition is ensuring patients eat properly. Doctors advise patients with this condition to avoid food and drinks that are hot or spicy, as they can worsen the irritation in the throat. In severe cases, patients may experience perforations (holes), ulcerations (sores), problems with food movement down the esophagus, and tracheoesophageal fistulas (an abnormal connection between the esophagus and windpipe).
While there isn’t a specific cure for radiation esophagitis, symptoms typically start to fade away 2 to 4 weeks after radiation treatment has ended.
What Causes Radiation Esophagitis?
Radiation esophagitis is a condition where the lining of the esophagus, the tube that carries food from your mouth to your stomach, gets inflamed and swollen. This condition is caused by radiation therapy, a treatment used to kill cancer cells. When radiation treatment is directed at or around the esophagus, it damages the cells and causes the body to produce substances known as proinflammatory cytokines. These substances cause inflammation.
Furthermore, radiation treatment can lead to the creation of free-oxygen radical species. These are unstable atoms that can damage cells, leading to illness and aging. These harmful effects from radiation therapy combine to cause inflammation, swelling, redness, and the breakdown of the lining of the esophagus, which characterizes radiation esophagitis.
Risk Factors and Frequency for Radiation Esophagitis
Radiation esophagitis is a possible side effect for people going through radiation therapy for cancer, especially for conditions like lung, breast, and other chest-related cancers. This happens because of the close position of the esophagus to these areas. Despite this, only a small number of people undergoing treatment experience serious issues linked to radiation esophagitis. It’s also believed that a person’s genes could impact their chance of developing this condition. There is ongoing research into how certain genetic variations (known as single-nucleotide polymorphisms) of a substance called transforming growth factor b-1 may be linked to severe cases of radiation esophagitis.
Some people may be more likely to develop radiation esophagitis due to specific risk factors. These include:
- being White,
- being over 70,
- being female,
- having a poor health status at the start of treatment,
- having a low body mass index,
- suffering from heartburn (or gastroesophageal reflux disease), and
- having difficulties swallowing (or dysphagia).
Signs and Symptoms of Radiation Esophagitis
People who develop a condition known as radiation esophagitis often have certain underlying factors. These can include poor overall health, being underweight, having acid reflux disease, or having difficulty swallowing. Additionally, individuals with tumors that have spread into their esophagus or those in later stages of cancer are also at a higher risk of developing radiation esophagitis.
When doctors check patients who have previously undergone radiation therapy for cancer, they always ask about any symptoms that might indicate the cancer has come back. These symptoms include weight loss, worsening breathing problems, difficulty swallowing, or a hoarse voice. It’s also important for them to thoroughly inspect the inside of the patient’s mouth for any signs of thrush or unusual sores, check for swollen lymph nodes, and conduct a detailed examination of the patient’s breathing.
- Difficulty swallowing
- Nausea
- Loss of appetite
- Painful swallowing
Testing for Radiation Esophagitis
Radiation esophagitis, a condition that occurs due to inflammation of the esophagus from radiation therapy, can occur either early (known as ‘acute’) or later on (known as ‘late’). Acute radiation esophagitis occurs within 3 months of treatment, mostly around 2 to 3 weeks after starting, while late radiation esophagitis happens more than 3 months post-treatment, typically within 6 months. Even though symptoms might get worse over time, they usually improve on their own. In severe cases, however, movement issues in the esophagus, openings, abnormal connections between organs (fistulas), and narrowings in the esophagus (strictures) can occur.
Normally, doctors can make a diagnosis based on symptoms and medical history. But, if there’s worry about more serious problems, more tests could be required. A barium swallow test, which involves swallowing a special liquid that shows up on X-rays, can be used to check for narrowings in the esophagus or issues with muscle contractions that help food move down the esophagus (peristaltic waves and dysmotility). A computed tomography (CT) scan of the chest and abdomen can help identify a fistula or further characterize strictures. An upper endoscopy, which uses a small camera to visualize the inside of the esophagus, may be done to find ulcers and, if needed, take a sample of tissue for examination (biopsy).
Treatment Options for Radiation Esophagitis
Treating your condition involves making sure you stay hydrated and maintain a healthy diet.
There is a certain drug called Amifostine which has been found to help protect against radiation damage. This medication appears to work by acting as an antioxidant, thereby offsetting the harmful oxygen particles that are produced during radiation treatment. One study conducted on patients with an advanced type of lung cancer found that while Amifostine improved swallowing issues, it didn’t reduce severe cases of esophagitis, which is inflammation of the food pipe. Glutamine is another potential protective agent against radiation, and it’s been linked with lower rates of esophagitis. One study found that almost half of the lung cancer patients who took Glutamine powder as a preventive measure didn’t experience esophagitis. There are also some anti-inflammatory drugs and other medications that have been studied, but as of now, they haven’t been found to be effective.
Changes to your diet can often help as well. This might involve switching to a diet of soft, bland foods and avoiding potentially irritating foods, such as alcohol, spicy foods, and very hot or cold items. It could also be helpful to eat small meals more frequently. If you’re struggling to maintain nutritional intake, you might need additional support, like supplement drinks, IV fluids, electrolyte replenishment, and even parenteral nutrition, which delivers nutrients directly into your bloodstream. You might also need pain relief in the form of topical treatments or systemic methods. Furthermore, given the increased risk of oral yeast infections, preventive antifungal therapy might be necessary.
In certain cases, when the food pipe becomes too narrow (a condition referred to as a stricture), it may need to be widened through a process called dilation. However, this procedure can potentially cause complications like accidental inhalation of food or drink into the airways (aspiration) or tearing of the food pipe (perforation).
In some reported cases, long narrowings of the food pipe have been relieved using stents, which are tubular support structures placed inside the food pipe to keep it open.
What else can Radiation Esophagitis be?
Radiation esophagitis, which is inflammation of the esophagus, could crop up either during the early or late phase of treatment. If individuals experience a severe form of this condition, they may face an increased risk for enduring complications. Therefore, healthcare providers must be skilled in identifying acute, potentially life-threatening complications. These could involve formation of ulcers, holes in the esophagus, abnormal connections between organs (fistulas), or an abnormal narrowing of the esophagus (strictures). Also, it’s crucial to ensure that these patients don’t have cytomegalovirus (CMV) esophagitis, which is a type of inflammation caused by a specific virus.
What to expect with Radiation Esophagitis
While the symptoms of radiation esophagitis may accumulate over time, they typically cease on their own. There isn’t a remedy to cure this condition, but don’t worry – the symptoms usually lessen or disappear 2 to 4 weeks after you finish your radiation treatments.
Possible Complications When Diagnosed with Radiation Esophagitis
Radiation esophagitis is generally mild and resolves on its own. However, in more severe instances, it can lead to complications like sores in the esophagus, tears in the esophageal wall, abnormal connections between the esophagus and windpipe, and narrowing of the esophagus. Genetics and variations in an individual’s DNA can influence the severity of these cases.
Possible Complications:
- Sores in the esophagus
- Tears in the esophageal wall
- Abnormal connections between the esophagus and windpipe
- Narrowing of the esophagus
Recovery from Radiation Esophagitis
It’s best to stay away from spicy foods and those that are very hot or cold. Food that is soft and bland, ideally pureed, is more suitable. A dietitian could be of help to figure out how many calories you need each day. Some people might need to take fluids and nutrients directly into their veins or through a tube inserted into their stomach.
If you’re feeling discomfort, this can be relieved with an oral solution called lidocaine, certain types of pain relievers called NSAIDs, and medicine to reduce stomach acid, known as proton pump inhibitors (PPIs).
Users are also advised to use a medicine called Nystatin, which is swished around the mouth and then swallowed. This is because people with this condition are often susceptible to mouth and throat infections caused by a fungus called Candida (also known as thrush or candida esophagitis).
Preventing Radiation Esophagitis
Various treatments have been researched to prevent radiation-induced esophagitis, a condition causing inflammation in the esophagus due to radiation therapy. These treatments include Amifostine, a radiation-protective drug; L glutamine, an amino acid; and NSAIDs, which are common pain relievers that also reduce inflammation. However, the results of these studies have been mixed.
The best way to prevent this condition is through early awareness of the symptoms and early dietary consultation. By consulting a nutritionist or dietitian early, patients can learn about dietary adjustments that may help prevent or manage the symptoms of esophagitis.
