Abstract
Background:Various methods have been used for treatment of hemorrhagic radiation proctitis (HRP) with variable results. Currently, the preferred treatment is formalin application or endoscopic therapy with argon plasma coagulation. Recently, a novel therapy with colonic water irrigation and oral antibiotics showed promising results and more effective compared to 4% formalin application for HRP. The study objective is to compare the effect of water irrigation and oral antibiotics versus 4% formalin application in improving per rectal bleeding due to HRP and related symptoms such as diarrhoea, tenesmus, stool frequency, stool urgency and endoscopic findings. Methods:We conducted a study on 34 patients with HRP and randomly assigned the patients to two treatment arm groups (n=17). The formalin group underwent 4% formalin dab and another session 4 weeks later. The irrigation group self-administered daily rectal irrigation at home for 8 weeks and consumed oral metronidazole and ciprofloxacin during the first one week. We measured the patients’ symptoms and endoscopic findings before and after total of 8 weeks of treatment in both groups. Results:Our study showed that HRP patients had reduced per rectal bleeding (p = 0.003) in formalin group, whereas irrigation group showed reduced diarrhoea (p=0.018) and tenesmus (p=0.024) symptoms. The comparison between the two treatment arms showed that irrigation technique was better than formalin technique for tenesmus (p=0.043) symptom only. Conclusion:This novel treatment showed benefit in treating HRP. It could be a new treatment option which is safe and conveniently self-administered at home or used as a combination with other therapies to improve the treatment outcome for HRP.
Highlights
Radiation injury has increased over the years as radiotherapy is widely used in current curative treatment for pelvic malignancies like prostate, urinary bladder, cervix, vagina, uterus and rectum
A novel therapy with colonic water irrigation and oral antibiotics showed promising results and more effective compared to 4% formalin application for hemorrhagic radiation proctitis (HRP)
The study objective is to compare the effect of water irrigation and oral antibiotics versus 4% formalin application in improving per rectal bleeding due to HRP and related symptoms such as diarrhoea, tenesmus, stool frequency, stool urgency and endoscopic findings
Summary
Radiation injury has increased over the years as radiotherapy is widely used in current curative treatment for pelvic malignancies like prostate, urinary bladder, cervix, vagina, uterus and rectum. Acute radiation proctitis occurs during or within 3 months of radiation due to direct mucosal damage It affects 50 – 70% of post radiotherapy patients with symptoms like abdominal cramps, rectal bleeding, mucus discharge, tenesmus or diarrhea which usually resolves spontaneously. It presents 3 months after completion of radiation with median onset at approximately 1 year This is caused by progressive epithelial atrophy and fibrosis associated with obliterative endarteritis and chronic mucosal ischemia (Caroline, 2010). The study objective is to compare the effect of water irrigation and oral antibiotics versus 4% formalin application in improving per rectal bleeding due to HRP and related symptoms such as diarrhoea, tenesmus, stool frequency, stool urgency and endoscopic findings.
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