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, Farooq Rahman and

Nutrients

One in three people will develop cancer at some point in their lives. Radiotherapy is used to treat approximately 50% of cancer patients. However, its toxic effect to the surrounding normal healthy tissue remains a major drawback.Ìý

Radiation-induced bowel injuryÌýis an undesirable and often debilitating consequence of radiation therapy for cancer, and most commonly occurs with radiotherapy to the abdomen and pelvic region. Between 60 and 80% of patients develop early intestinal inflammation which recedes within a few months; however, a significant number develop ‘delayed’ bowel toxicity, characterised by chronic inflammation and ischaemia resulting in irreversible mucosal atrophy, intestinal fibrosis and microvascular sclerosis. Once established, this is a chronic progressive irreversible condition.Ìý

The pathophysiology of radiation-induced bowel injury is poorly understood, although we now know that it derives from a complex interplay of epithelial injury and alterations in the enteric immune, nervous, and vascular systems in genetically predisposed individuals. Furthermore, evidence supporting a pivotal role for the gut microbiota in the development of radiation-induced bowel injury has been growing.Ìý

In this review, we aim to appraise our current understanding of radiation-induced bowel injury and the role of the microbiome in its pathogenesis as well as prevention and treatment. Greater understanding of the relationship between the disease mechanism of radiation-induced bowel injury and gut microbiome might shed light on potential future prevention and treatment strategies through the modification of a patient’s gut microbiome.