title: Sucralfate paste enema: a new method of topical treatment for haemorrhagic radiation proctitis.
abstract: OBJECTIVE
  Rectal sucralfate has been reported to deliver clinical improvement in haemorrhagic radiation proctitis, but patients with active proctitis find the enema suspension difficult to retain thus reducing compliance and effectiveness. We describe a novel method of rectal administration via a low-volume sucralfate paste and report its results in a series of 23 patients.
  
  
  METHODS
  Patients with rectal bleeding occurring more than 6 months after radiotherapy were shown how to prepare and self-administer sucralfate paste enemas (SPEs) twice daily for 6 weeks. The SPE was prepared using two sucralfate 1-g tablets mixed with 4.5 ml of water in an enema applicator producing a low-volume paste. The clinical response was evaluated by comparison of pre- and posttreatment clinical proctitis scores (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer).
  
  
  RESULTS
  Eighteen male (postprostatic radiotherapy) and five female (postcervical radiotherapy) patients with a median age of 67 (32-75) years were included. The median interval between pelvic irradiation and SPE treatment was 24 (7-69) months. Twenty-two patients had full clinical scoring, of whom 16 (73%) demonstrated clinical improvement. Six (27%) had neither clinical improvement nor deterioration. Seven (32%) had resolution of all symptoms.
  
  
  CONCLUSIONS
  Most patients demonstrated clinical improvement. This initial experience of the sucralfate paste enema may provide the basis for a prospective study of its effectiveness in the treatment of haemorrhagic radiation proctitis.
authors.affiliation: Department of Colorectal Surgery, Royal Victoria Hospital, Belfast, UK.
authors.forename: K
authors.initials: K
authors.lastname: McElvanna
authors.forename: A
authors.initials: A
authors.lastname: Wilson
authors.forename: T
authors.initials: T
authors.lastname: Irwin
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004733:Enema; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments; D011349:Proctitis / Q000188:drug therapy*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000188:drug therapy*; D013392:Sucralfate / Q000627:therapeutic use*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
chemical_list: D000897:Anti-Ulcer Agents; D009824:Ointments; D013392:Sucralfate
keywords: Sucralfate; proctitis; radiation