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home - Oesophagus - Miscellaneous - Radiation Oesophagitis Written by Dr Sebastian Zeki
Nausea and Vomiting:
Understands the pathophysiology of vomiting.
Appreciates the gastrointestinal conditions that cause nausea and
vomiting as well as the range of extra-intestinal causes

Recognises the influence of neurological conditions and metabolic
derangements such as diabetes

Understands the physiology of gastric emptying and how this is
affected by disease, toxins and drugs

Abdominal Pain:
Knows the causes of acute and chronic abdominal pain that arise
from upper gastrointestinal, biliary and pancreatic diseases

Understands the clinical presentations of the various conditions
causing pain and the means by which they can be diagnosed and
treated

Weight Loss:
Knows the significance of weight loss as a consequence of upper
gastrointestinal disease, knows those conditions that present with
loss of weight and how they are managed

Skills
Makes a detailed clinical assessment of patients presenting with
symptoms indicating possible upper gastrointestinal disease,
construct a management plan and be aware of the various avenues
of treatment

Behaviours
Evaluates patients in a structured and timely manner, carries out
appropriate investigations and formulates management plan.

Radiation Oesophagitis

Oesophagitis5 % will develop complications at 5years after 60 Gy when 1/3rd of the oesophageal length is irradiated.Brachytherapy may increase the risk of fistula formation.Maximal oesophageal 'point' dose of 69 Gy with RT alone and 58 Gy with concurrent chemotherapy predicts significant oesoph-geal toxicity.Severe toxicity is more common in those receiving concurrent chemotherapy. Damages basal epithelial layer Subsequent mucosal thinning and occasional denudation.2-3wks after initiation of RT. Endoscopic features: Mucositis and ulceration is observed.Toxicity rarely causes oesophageal perforation or bleeding. After completion of treatment regeneration occurs in 3 weeks. Chronic Effects:Epithelial thickening.Chronic inflammation.Submucosal or muscularis fibrosis.Dysphagia- stricture (due to fibrosis after 4-8 months).Altered motility (due to muscular damage or nerve injury after 1-3 months).Chronic ulceration- rare and total radiation dose related.Fistula formation- rare. Radiation Oesophagitis TreatmentTreatment of acute oesophagitis is the same as the manage-ment of relux oesophagitis- rarely need to stop treatment.Treatment of oesophageal strictures usually involves endoscopic dilatation- may require many sessions.The best studied prevention is amifostine in NSCLC a free radical scavenger- results are conflicting Can lead to Written by Dr Sebastian Zeki

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