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Dmitri Popov. PhD, Radiobiology. MD (Russia)
Advanced Medical Technology and Systems Inc. Canada.
Acute Radiation Gastro-Intestinal
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.
Acute Gastro-Intestinal Radiation
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.
Acute Gastro-Intestinal Radiation
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.
Acute Gastro-Intestinal Radiation
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.
Acute Gastro-Intestinal Radiation
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.
Acute Gastro-Intestinal Radiation
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.
Acute Gastro-Intestinal Radiation Syndrome.
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.
Acute Gastro-Intestinal Radiation Syndrome.
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.
Acute Gastro-Intestinal Radiation Syndrome.
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.
Acute Gastro-Intestinal Radiation Syndrome.
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.
Acute Gastro-Intestinal Radiation Syndrome.
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.
Acute Gastro-Intestinal Radiation Syndrome.
Mild Grade of Gastro- Intestinal ARS.
Death in 10 - 15 days
Acute Gastro-Intestinal Radiation Syndrome.
Moderate Grade of Gastro- Intestinal ARS.
Death in 5-7 days
Acute Gastro-Intestinal Radiation Syndrome.
Severe Grade of Gastro- Intestinal ARS.
Death in 2 - 3 days.