Radiation proctitis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Acute radiation proctitis is a self limiting condition and treated conservatively however in 20% of cases undergoing external beam radiation will require short interruptions in their treatment to improve symptoms.In case of chronic radiation proctitis treatment usually depends upon the severity and pattern of the symptoms. | Acute radiation proctitis is a self limiting condition and treated conservatively however in 20% of cases undergoing external beam radiation will require short interruptions in their treatment to improve symptoms.In case of chronic radiation proctitis treatment usually depends upon the severity and pattern of the symptoms. | ||
==Medical Therapy== | ==Medical Therapy== | ||
* Symptoms such as diarrhea and painful defectation may be treated with oral [[opioids]] and stool softeners, respectively. | * Symptoms such as diarrhea and painful defectation may be treated with oral [[opioids]] and stool softeners, respectively. | ||
* Several other methods are under development as of 2005 to lessen the effects of radiation proctitis. These include [[sucralfate]],[[vitamin A]] , | * Several other methods are under development as of 2005 to lessen the effects of radiation proctitis. These include [[sucralfate]], [[vitamin A]], [[hyperbaric oxygen therapy]], [[corticosteroid]]s, [[metronidazole]], and [[argon plasma coagulation]].<ref name="pmid1670631">{{cite journal| author=Kochhar R, Patel F, Dhar A, Sharma SC, Ayyagari S, Aggarwal R et al.| title=Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. | journal=Dig Dis Sci | year= 1991 | volume= 36 | issue= 1 | pages= 103-7 | pmid=1670631 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1670631 }}</ref><ref name="pmid9293933">{{cite journal| author=Talley NA, Chen F, King D, Jones M, Talley NJ| title=Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial. | journal=Dis Colon Rectum | year= 1997 | volume= 40 | issue= 9 | pages= 1046-50 | pmid=9293933 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9293933 }}</ref><ref name="pmid9013165">{{cite journal| author=Jensen DM, Machicado GA, Cheng S, Jensen ME, Jutabha R| title=A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. | journal=Gastrointest Endosc | year= 1997 | volume= 45 | issue= 1 | pages= 20-5 | pmid=9013165 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9013165 }}</ref><ref name="pmid10378604">{{cite journal| author=Pinto A, Fidalgo P, Cravo M, Midões J, Chaves P, Rosa J et al.| title=Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis: randomized, double-blind, controlled trial. | journal=Dis Colon Rectum | year= 1999 | volume= 42 | issue= 6 | pages= 788-95; discussion 795-6 | pmid=10378604 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10378604 }}</ref><ref name="pmid10962052">{{cite journal| author=Cavcić J, Turcić J, Martinac P, Jelincić Z, Zupancić B, Panijan-Pezerović R et al.| title=Metronidazole in the treatment of chronic radiation proctitis: clinical trial. | journal=Croat Med J | year= 2000 | volume= 41 | issue= 3 | pages= 314-8 | pmid=10962052 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10962052 }}</ref><ref name="pmid11869662">{{cite journal| author=Denton A, Forbes A, Andreyev J, Maher EJ| title=Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. | journal=Cochrane Database Syst Rev | year= 2002 | volume= | issue= 1 | pages= CD003455 | pmid=11869662 | doi=10.1002/14651858.CD003455 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11869662 }}</ref><ref name="pmid92939332">{{cite journal| author=Talley NA, Chen F, King D, Jones M, Talley NJ| title=Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial. | journal=Dis Colon Rectum | year= 1997 | volume= 40 | issue= 9 | pages= 1046-50 | pmid=9293933 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9293933 }}</ref><ref name="pmid26198994">{{cite journal| author=Vanneste BG, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN| title=Chronic radiation proctitis: tricks to prevent and treat. | journal=Int J Colorectal Dis | year= 2015 | volume= 30 | issue= 10 | pages= 1293-303 | pmid=26198994 | doi=10.1007/s00384-015-2289-4 | pmc=4575375 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26198994 }}</ref><ref name="pmid15690650">{{cite journal| author=Ehrenpreis ED, Jani A, Levitsky J, Ahn J, Hong J| title=A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) for symptomatic chronic radiation proctopathy. | journal=Dis Colon Rectum | year= 2005 | volume= 48 | issue= 1 | pages= 1-8 | pmid=15690650 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15690650 }}</ref><ref name="pmid29948565">{{cite journal| author=Tabaja L, Sidani SM| title=Management of Radiation Proctitis. | journal=Dig Dis Sci | year= 2018 | volume= 63 | issue= 9 | pages= 2180-2188 | pmid=29948565 | doi=10.1007/s10620-018-5163-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29948565 }}</ref><ref name="pmid11072170">{{cite journal| author=Hovdenak N, Fajardo LF, Hauer-Jensen M| title=Acute radiation proctitis: a sequential clinicopathologic study during pelvic radiotherapy. | journal=Int J Radiat Oncol Biol Phys | year= 2000 | volume= 48 | issue= 4 | pages= 1111-7 | pmid=11072170 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11072170 }}</ref> | ||
{{familytree/start}}{{familytree | | | | | | | | | A01 | | | | | |A01=Clinical suspicion of CRP}} | ==== Treatment Algorithm of Chronic radiation proctitis ==== | ||
{{familytree | | | | | | | | | |!| | | | | | | | }} | <br />{{familytree/start}}{{familytree || || | | | | | | | A01 | | | | | |A01=Clinical suspicion of [[CRP]]}} | ||
{{familytree | | | | | | | | | B01 | | | | | |B01=Flexible endoscopy to determine the cause}} | {{familytree ||| | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | {{familytree ||| | | | | | | | | B01 | | | | | |B01=Flexible [[endoscopy]] to determine the cause}} | ||
{{familytree | | C01 | | | | | | | | | | | |C02|C01=Inflammation-predominate form of CRP|C02=Bleeding-predominate form of the CRP}} | {{familytree ||| | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | ||
{{familytree | || C01 | | | | | | | | | | | |C02|C01=Inflammation-predominate form of [[CRP]]|C02=Bleeding-predominate form of the [[CRP]]}} | |||
{{familytree | | |!| | | | | | | | | | | | | |!| }} | {{familytree | | |!| | | | | | | | | | | | | |!| }} | ||
{{familytree | | D01 | | | | | | | | | | | |D02|D01=Treatment<br>Loperamide,fibers,stool bulking agents and corticosteroids''|D02= | {{familytree | | D01 | | | | | | | | | | | |D02|D01=Treatment<br> [[Loperamide]], [[fibers]], stool bulking agents and [[corticosteroids]]''|D02=Optimize bowel function and stool consistency to reduce amount of bleeding<br>Start eventually antioxidentia(Vit A,C,E) or [[antibiotics]]([[Metronidazole]])}} | ||
{{familytree | | || | | | | | | | | | | {{familytree |||| ||| |||,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | ||
{{familytree | | | | | | | | | | | | {{familytree | | | | | | | | | E02 || | |||| ||| |E03|E02=If the bleeding affecting the quality of life, start [[sucralfate]] enema and if possible, stop or reduce the [[anticoagulants]]|E03=If the bleeding is not affecting the quality of life then reassure}} | ||
{{familytree | {{familytree | || | | | | | | | |!| | | ||| | | | | }} | ||
{{familytree | {{familytree | || || ||| | || F01 |F01=Discuss definitive treatment to ablate the [[telangiectasia]] by Argon plasma coagulation, formalin therapy or if accessible hyperbaric oxygen therapy and if fistula/stricture not healing then surgery|}} | ||
{{familytree/end}} | {{familytree/end}} | ||
==References== | ==References == | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 23:42, 6 November 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Acute radiation proctitis is a self limiting condition and treated conservatively however in 20% of cases undergoing external beam radiation will require short interruptions in their treatment to improve symptoms.In case of chronic radiation proctitis treatment usually depends upon the severity and pattern of the symptoms.
Medical Therapy
- Symptoms such as diarrhea and painful defectation may be treated with oral opioids and stool softeners, respectively.
- Several other methods are under development as of 2005 to lessen the effects of radiation proctitis. These include sucralfate, vitamin A, hyperbaric oxygen therapy, corticosteroids, metronidazole, and argon plasma coagulation.[1][2][3][4][5][6][7][8][9][10][11]
Treatment Algorithm of Chronic radiation proctitis
| Clinical suspicion of CRP | |||||||||||||||||||||||||||||||||||||||||||||||||
| Flexible endoscopy to determine the cause | |||||||||||||||||||||||||||||||||||||||||||||||||
| Inflammation-predominate form of CRP | Bleeding-predominate form of the CRP | ||||||||||||||||||||||||||||||||||||||||||||||||
| Treatment Loperamide, fibers, stool bulking agents and corticosteroids | Optimize bowel function and stool consistency to reduce amount of bleeding Start eventually antioxidentia(Vit A,C,E) or antibiotics(Metronidazole) | ||||||||||||||||||||||||||||||||||||||||||||||||
| If the bleeding affecting the quality of life, start sucralfate enema and if possible, stop or reduce the anticoagulants | If the bleeding is not affecting the quality of life then reassure | ||||||||||||||||||||||||||||||||||||||||||||||||
| Discuss definitive treatment to ablate the telangiectasia by Argon plasma coagulation, formalin therapy or if accessible hyperbaric oxygen therapy and if fistula/stricture not healing then surgery | |||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Kochhar R, Patel F, Dhar A, Sharma SC, Ayyagari S, Aggarwal R; et al. (1991). "Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate". Dig Dis Sci. 36 (1): 103–7. PMID 1670631.
- ↑ Talley NA, Chen F, King D, Jones M, Talley NJ (1997). "Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial". Dis Colon Rectum. 40 (9): 1046–50. PMID 9293933.
- ↑ Jensen DM, Machicado GA, Cheng S, Jensen ME, Jutabha R (1997). "A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia". Gastrointest Endosc. 45 (1): 20–5. PMID 9013165.
- ↑ Pinto A, Fidalgo P, Cravo M, Midões J, Chaves P, Rosa J; et al. (1999). "Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis: randomized, double-blind, controlled trial". Dis Colon Rectum. 42 (6): 788–95, discussion 795-6. PMID 10378604.
- ↑ Cavcić J, Turcić J, Martinac P, Jelincić Z, Zupancić B, Panijan-Pezerović R; et al. (2000). "Metronidazole in the treatment of chronic radiation proctitis: clinical trial". Croat Med J. 41 (3): 314–8. PMID 10962052.
- ↑ Denton A, Forbes A, Andreyev J, Maher EJ (2002). "Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis". Cochrane Database Syst Rev (1): CD003455. doi:10.1002/14651858.CD003455. PMID 11869662.
- ↑ Talley NA, Chen F, King D, Jones M, Talley NJ (1997). "Short-chain fatty acids in the treatment of radiation proctitis: a randomized, double-blind, placebo-controlled, cross-over pilot trial". Dis Colon Rectum. 40 (9): 1046–50. PMID 9293933.
- ↑ Vanneste BG, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN (2015). "Chronic radiation proctitis: tricks to prevent and treat". Int J Colorectal Dis. 30 (10): 1293–303. doi:10.1007/s00384-015-2289-4. PMC 4575375. PMID 26198994.
- ↑ Ehrenpreis ED, Jani A, Levitsky J, Ahn J, Hong J (2005). "A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) for symptomatic chronic radiation proctopathy". Dis Colon Rectum. 48 (1): 1–8. PMID 15690650.
- ↑ Tabaja L, Sidani SM (2018). "Management of Radiation Proctitis". Dig Dis Sci. 63 (9): 2180–2188. doi:10.1007/s10620-018-5163-8. PMID 29948565.
- ↑ Hovdenak N, Fajardo LF, Hauer-Jensen M (2000). "Acute radiation proctitis: a sequential clinicopathologic study during pelvic radiotherapy". Int J Radiat Oncol Biol Phys. 48 (4): 1111–7. PMID 11072170.