From the Guidelines
Topical sucralfate enemas are the most effective treatment option for radiation-induced proctitis, as they provide a protective barrier over the inflamed rectal mucosa and promote healing. The use of sucralfate enemas is supported by the most recent and highest quality study, which recommends their use in patients with radiation-induced rectal bleeding 1.
Treatment Options
- Topical sucralfate enemas (2 grams in 20 ml of water, administered once or twice daily) can provide a protective barrier over the inflamed rectal mucosa and promote healing.
- Other treatment options, such as topical corticosteroid enemas or suppositories, and short-chain fatty acid enemas, may also be considered, but their effectiveness is not as well established as sucralfate enemas.
- Topical 5-aminosalicylic acid (5-ASA) preparations, such as mesalamine suppositories or enemas, are not recommended as they may exacerbate acute radiation-induced intestinal inflammation 1.
Important Considerations
- The treatment duration typically ranges from 2-8 weeks depending on symptom response, and patients should be advised to retain enemas for at least 30 minutes when possible for maximum effectiveness.
- It is essential to investigate the cause of bleeding with flexible endoscopy and optimize bowel function and stool consistency to reduce the amount of bleeding 1.
- Patients with radiation-induced proctitis should be aware of the potential risks and complications associated with endoscopic and surgical interventions, including fistula formation and perforation 1.
From the Research
Topical Treatment Options for Radiation-Induced Proctitis
- Formalin application: Studies have shown that formalin application is a effective treatment for radiation-induced hemorrhagic proctitis 2, 3, 4. A 10 percent buffered formalin solution can be applied directly to the affected mucosa using a cotton tip applicator 2. Alternatively, a 4 percent formalin solution can be instilled into the rectum in 50-ml aliquots 4.
- Argon plasma coagulation: This is a simple, safe, and efficacious therapy for mild to moderate radiation proctitis 3. However, in patients with severe radiation proctitis, several sessions may be necessary, and success is not certain.
- Sucralfate enemas: Sucralfate suspension can be used as an effective first-line agent for managing patients with chronic hemorrhagic radiation proctitis 5.
Other Treatment Options
- Non-steroid anti-inflammatory drugs (NSAIDs)
- Anti-oxidants
- Short chain fatty acids
- Hyperbaric oxygen
- Endoscopic YAG laser coagulation
- Surgery as a last resort 6