A novel treatment for haemorrhagic radiation proctitis using colonic irrigation and oral antibiotic administration.
OBJECTIVE
Radiation-induced haemorrhagic proctitis is not uncommon after radiotherapy for pelvic malignancy. Various treatments have been described. Recurrent bleeding and subsequent complications associated with treatment have been reported. Colonic irrigation has been used to treat defaecation disorders; however, it has not been used to treat radiation-induced proctitis.


METHODS
A pilot study was undertaken of 12 patients with haemorrhagic radiation proctitis after radiotherapy. Four patients had had cervical cancer, five had uterine cancer, one had prostatic cancer, one had vesical cancer and one had vaginal cancer. Daily self-administered colonic irrigation with tap water and a 1-week period of oral antibiotics (ciprofloxacin and metronidazole) were prescribed.


RESULTS
The median dose of radiation given was 54 (50-70) Gy. The median interval from radiation to the development of haemorrhagic proctitis was 26 (8-44) months. The median duration of symptomatic rectal haemorrhage prior to treatment was 8 (1-48) months. There was a significant improvement in rectal bleeding after treatment with colonic irrigation and oral antibiotic administration, accompanied by an improvement in bowel frequency and urgency, and diarrhoea. There were no complications. The majority of the patients (11/12) were satisfied with the treatment. The five patients who had previously undergone formalin therapy preferred the treatment regimen used in this study.


CONCLUSIONS
The preliminary results of colonic irrigation and oral antibiotics indicate that this treatment is safe and effective for radiation-induced proctitis. Further study is warranted.
Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. chucheep@hotmail.com
C
C
Sahakitrungruang
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S
Thum-Umnuaysuk
A
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Patiwongpaisarn
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P
Atittharnsakul
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A
Rojanasakul
D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010865:Pilot Projects; D011349:Proctitis / Q000209:etiology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy; D014625:Vaginal Neoplasms / Q000532:radiotherapy
D000890:Anti-Infective Agents; D008795:Metronidazole; D002939:Ciprofloxacin