title: Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension.
abstract: Rectal bleeding due to radiation proctosigmoiditis is often difficult to manage. We had earlier shown the efficacy of short-term therapy with topical sucralfate in controlling bleeding in the radiation proctosigmoiditis. We now report our long-term results with this form of therapy. The study comprised 26 patients with radiation proctosigmoiditis. Sigmoidoscopically, 9 (34.6%) patients had severe changes, 15 (57.69%) had moderate, and 2 (7.69%) had mild changes. Severity of bleeding was graded as severe (> 15 episodes per week), moderate (8-14 episodes per week), mild (2-7 episodes per week), negligible (< or = 1 episode per week), or nil (no bleeding). Ten patients had moderate rectal bleeding, while 16 had severe bleeding. All patients were treated with 20 ml of 10% rectal sucralfate suspension enemas twice a day until bleeding per rectum ceased or failure of therapy was acknowledged. Response to therapy was considered good whenever the severity of bleeding showed improvement by a change of two grades. Rectally administered sucralfate achieved good response in 20 (76.9%) patients at 4 weeks, 22 (84.6%) patients at 8 weeks, and 24 (92.3%) patients at 16 weeks. This change was significant by Wilcoxon matched-pairs signed-ranks test. Two patients required surgery due to poor response. Over a median follow-up of 45.5 months (range 5-73 months) after cessation of bleeding, 17 (70.8%) patients had no further bleeding while 7 (22.2%) had recurrence of bleeding. All recurrences responded to short-term reinstitution of therapy. No treatment-related complications were observed. Ten patients had other associated late toxicity due to pelvic irradiation in the form of asymptomatic rectal stricture (N = 3), rectovaginal fistula (N = 1), intestinal stricture (N = 1), vaginal stenosis (N = 1), and hematuria (N = 6). Three patients had progression of the primary disease in the form of pelvic recurrence (N = 2) and hepatic metastases (N = 1). We conclude that topical sucralfate induces a lasting remission in a majority of patients with moderate to severe rectal bleeding due to radiation proctosigmoiditis.
authors.affiliation: Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: R
authors.initials: R
authors.lastname: Kochhar
authors.forename: P V
authors.initials: PV
authors.lastname: Sriram
authors.forename: S C
authors.initials: SC
authors.lastname: Sharma
authors.forename: R C
authors.initials: RC
authors.lastname: Goel
authors.forename: F
authors.initials: F
authors.lastname: Patel
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011350:Proctocolitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011832:Radiation Injuries / Q000188:drug therapy*; D011879:Radiotherapy Dosage; D012002:Rectal Diseases / Q000209:etiology; D013392:Sucralfate / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy
chemical_list: D005765:Gastrointestinal Agents; D013392:Sucralfate