From the Guidelines
Sucralfate can be used to treat radiation colitis, specifically through the use of sucralfate enemas, as suggested by the ESMO clinical practice guidelines 1. The typical regimen involves 1-2 grams of sucralfate administered as an enema once or twice daily for 2-4 weeks. Sucralfate works by forming a protective barrier over inflamed or damaged intestinal mucosa, allowing healing to occur while reducing symptoms like rectal bleeding, diarrhea, and pain. The medication adheres to the damaged tissue, creating a physical shield against further irritation from digestive acids and enzymes. It may also stimulate local production of protective prostaglandins and growth factors that promote healing. Patients should be aware that response may take several days to weeks, and the medication should be continued as prescribed even if symptoms improve. Side effects are generally minimal but may include constipation when taken orally. For enema administration, patients should try to retain the solution for 30-60 minutes when possible for maximum effectiveness, as guided by the preparation and administration instructions 1. While not FDA-approved specifically for radiation colitis, sucralfate represents a reasonable treatment option with a good safety profile, especially considering the suggestions from the ESMO guidelines 1. It's worth noting that oral sucralfate is not recommended for preventing gastrointestinal mucositis or reducing related side-effects of radiotherapy 1, but the use of sucralfate enemas is specifically suggested for treating chronic radiation-induced proctitis in patients with rectal bleeding 1.
From the Research
Treatment Options for Radiation Colitis
- Radiation colitis can be difficult to treat, with various options available to manage its symptoms, including argon plasma coagulation, topical formaldehyde, stool softeners, colonic dilation, and steroid injection 2.
- Surgery is usually avoided due to technical difficulties and high incidence of postoperative complications 2.
Use of Sucralfate in Radiation Colitis
- Sucralfate has been shown to be useful in non-acid related gastrointestinal diseases, including radiation-induced mucosal procto-sigmoiditis or ulcerative colitis 3.
- The drug forms a physical barrier between epithelium and damaging agents, increases local levels of fibroblast growth factors, and induces a rise in mucosal concentration of prostaglandins, which are important factors in mucosal healing 3.
- Studies have investigated the use of sucralfate in radiation oncology, with some results indicating a significant amelioration of clinical symptoms and morphological changes in patients with pelvic irradiation 4.
Clinical Trials on Sucralfate for Radiation Colitis
- A North Central Cancer Treatment Group phase III double-blind placebo-controlled trial found that sucralfate did not decrease pelvic RT-related bowel toxicity and seemed to aggravate some gastrointestinal symptoms 5.
- Another study suggested that sucralfate treatment during radiotherapy for pelvic cancer leads to a significant amelioration of clinical symptoms and morphological changes 4.
- However, the effectiveness of sucralfate in treating radiation colitis is still unclear, with conflicting results from different studies 4, 5.