Radiation proctitis: inflammatory management.

  Colonoscopy, General GE

Management of radiation proctitis. This article focusses on the inflammatory component. For bleeding complications needing endoscopic treatment see radiation proctitis: endoscopic treatment of bleeding.

This overview cites two articles and included their treatment algorithm. Below that is a general information section on radiation proctitis.

Vanneste BG, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. Int J Colorectal Dis. 2015;30(10):1293‐1303. doi:10.1007/s00384-015-2289-4
Do NL, Nagle D, Poylin VY. Radiation proctitis: current strategies in management. Gastroenterol Res Pract. 2011;2011:917941. doi:10.1155/2011/917941

General information

Radiation proctitis can be the result of radiotherapy of all pelvic organs. Incidence of ranges from 2 to 20 percent. Doses of radiation below 45 Gy are generally not associated radiation proctitis but can occur. Risk factors are inflammatory bowel disease and HIV/AIDS. Radiation proctitis can be acute which may result temporally halting radiation session or it can develop months to years later. Symptoms include diarrhea, urgency, tenesmus and bleeding. Bleeding occurs more in chronic radiation proctitis. Late complications can also include strictures. Symptoms are not specific. Differential diagnosis include inflammatory bowel disease, most often ulcerative colitis, CMV, HSV, Giardia, bacterial infection, Gonorrhoeae, Lymphogranuloma venereum (LGV), NSAIDS use and ischemia . Work-up can include, general blood tests including CRP, stool examination, STD testing, endoscopy including biopsies (if possible, risk of bleeding). Endoscopic findings in patients with radiation proctitis are not specific and include vulnerable mucosa, fibrosis, telangiectasias, edema, erythema, ulcera and fistulas. Histologic findings can include eosinophilia, fibrosis, and capillary telangiectasia. Histologic findings can sometimes distinguish between radiation proctitis and inflammatory bowel disease. In case of fistulas and MRI can be performed.

References:

Do NL, Nagle D, Poylin VY. Radiation proctitis: current strategies in management. Gastroenterol Res Pract. 2011;2011:917941. doi:10.1155/2011/917941

Leiper K, Morris AI. Treatment of radiation proctitis. Clin Oncol (R Coll Radiol). 2007;19(9):724‐729. doi:10.1016/j.clon.2007.07.008

Paquette, Ian M. M.D.1; Vogel, Jon D. M.D.2; Abbas, Maher A. M.D.3; Feingold, Daniel L. M.D.4; Steele, Scott R. M.D., M.B.A.5; On behalf of the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Chronic Radiation Proctitis, Diseases of the Colon & Rectum: October 2018 – Volume 61 – Issue 10 – p 1135-1140 doi: 10.1097/DCR.0000000000001209

Placer C, Lizarazu A, Borda N, Elósegui JL, Enriquez Navascués JM. Proctitis actínica, hemorrágica crónica y refractaria. Experiencia con formaldehído al 4% [Radiation proctitis and chronic and refractory bleeding. Experience with 4% formaldehyde]. Cir Esp. 2013;91(2):111‐114. doi:10.1016/j.ciresp.2012.05.017

Tagkalidis PP, Tjandra JJ. Chronic radiation proctitis. ANZ J Surg 2001; 71:230.

Vanneste BG, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. Int J Colorectal Dis. 2015;30(10):1293‐1303. doi:10.1007/s00384-015-2289-4

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