Abstract

Hyperbaric Oxygen Therapy for Chronic Radiation Enteritis Gary T. Marshall, Richard C. Thirlby, James E. Bredfeldt, Neil B. Hampson HYPOTHESIS: Hyperbaric oxygen therapy (HBO2) is a useful treatment for chronic radiation enteritis. DESIGN: Retrospective case series of 58 consecutive patients treated with HBO2 for chronic radiation enteritis between July 1991 and December 2002. SETTING:A tertiary community teaching hospital. PATIENTS: 58 patients (33male, 25 female;mean age 65 years) irradiated formalignant disease were treated with HBO2 for radiation injury to the alimentary tract. INTERVENTIONS: Patients were treated with an initial series of 30 daily treatments, each administering 90 minutes of 100% oxygen at 2.36 atmospheres absolute. Thirty patients with partial symptom response and/or endoscopic evidence of healing received an additional 6 to 30 treatments. MAIN OUTCOME MEASURES: Main outcome measures included resolution of bleeding, pain, weight loss, diarrhea and tenesmus. Endoscopic documentation of healing was used when available. RESULTS: The primary indication for hyperbaric oxygen treatment was bleeding in 49 patients, 15 of whom required transfusions. Additional symptoms were pain, urgency, diarrhea, ulceration, partial bowel obstruction, malabsorption and fistula formation. The mean interval between completion of radiation treatment and beginning HBO2 was 43 months (range = 2-288 months). For all patients, 28 (48%) had a complete response, 17 (29%) a partial response, and 13 (22%) failed to respond. Follow-up ranged from 1 to 60 months. Several patients responded during treatment but relapsed and are included with the failure or partial response groups as appropriate. The partial/ complete response rate for rectal disease was 77% and for all other sites was 80%. The partial/complete response rate for those with bleeding was 80% and for nonbleeding symptoms (eg obstruction, fistula, malabsorption) was 67%. CONCLUSION: The present series represents the largest report of hyperbaric oxygen therapy for radiation injury to the GI tract. Although this study is limited by the subjective nature of presenting symptoms and evaluation of response to treatment, we believe the results support the conclusion that HBO2 results in healing or clinically significant improvement in over 75% of patients with severe chronic radiation enteritis.

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