Radiation proctitis medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(19 intermediate revisions by 2 users not shown)
Line 4: Line 4:


==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.<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>
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]] ,<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> [[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>
* 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=D02'<br>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 | | | | | | | | | | | E02 || | | || |E03| E02=E02|E03=E03|}}
{{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 | | | | | | | | | | | | F01  |F01=F01|}}
{{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

Radiation proctitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Radiation proctitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Radiation proctitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Radiation proctitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Radiation proctitis medical therapy

CDC on Radiation proctitis medical therapy

Radiation proctitis medical therapy in the news

Blogs on Radiation proctitis medical therapy

Directions to Hospitals Treating Radiation proctitis

Risk calculators and risk factors for Radiation proctitis medical therapy

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

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.

Template:WH Template:WS