Table 1.

Clinical guidance for treatment of radiation-induced small bowel disease.

All patients	Acute radiation-induced small bowel disease	Chronic radiation-induced small bowel disease
Thorough clinical assessment including referral to a gastroenterologist	Liaison with radiotherapy provider in case modification of treatment regimen is required	Referral to a gastroenterologist
Consideration of differential diagnoses for each symptom and secondary causes of GI symptoms such as SBO and BAM	Supportive treatments and reassurance of patient that symptoms often resolve after course of radiotherapy is completed (consensus opinion from National Cancer Institute guidelines)	Investigate and treat secondary effects of radiation-induced small bowel disease
Supportive treatments such and antidiarrhoeals, anti-emetics etc (consensus opinion from National Cancer Institute guidelines)	Consider octreotide for the treatment of persistent diarrhoeal symptoms (RCT data)	Monitor for nutritional deficiencies and provide dietetic input. Consider TPN if evidence of intestinal failure
Nutritional assessment and support if required (consensus opinion from National Cancer Institute guidelines)	Avoid 5-ASA compounds (RCT data)	Hyperbaric oxygen for refractory symptoms (RCT data)
		Consider pentoxifylline and tocopherol (non RCT data)
		Consider endoscopic therapies if available and symptoms such as recurrent anaemia and/or bleeding (RCT data)
		Surgery can be considered in specialist centres for refractory cases but caution is advised due to high morbidity

5-ASA, 5-aminosalicylic acid; BAM, bile acid malabsorption; GI, gastrointestinal; RCT, randomized controlled trial; SBO, small intestinal bacterial overgrowth; TPN, total parenteral nutrition.