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Risks of Radiation Injury in IBD Patients

Adam B Kaufman, MD, and David T Rubin, MD

IBD is a chronic and recurring disease involving the gastrointestinal tract with associated potential complications and extra-intestinal manifestations. Patients often require extensive and repetitive diagnostic medical imaging procedures to evaluate the extent of the disease and possible complications over long periods of time. Imaging generally occurs at the time of initial diagnosis, prior, during, and after symptom flaring to assess disease activity or response to therapy, and peri-operatively if surgical management is required. There are multiple options for radiographic study, each with its own advantages and disadvantages. Thus, the potential exists for patients to be exposed to high amounts of ionizing radiation throughout a lifetime of disease. Epidemiological data exist to suggest that both acute exposure and protracted exposure can be associated with an increased risk of malignancy, and that this risk is greatest when exposure is at younger ages. Recent attention has focused on the overall increased lifetime cancer risk and excess cancer mortality related to ionizing radiation from diagnostic imaging required in the management of IBD. There is clearly a subset of IBD patients with more severe or persistent disease that requires repeated evaluation throughout the course of their disease; ultimately, these patients will be exposed to levels of radiation that could potentially result in harm. Efforts to understand these risks, to clarify provider and patient education, and to identify options that minimize cumulative exposure are ongoing. Inflamm Bowel Dis Monit 2010;10(4):126–30.

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