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Thursday, 5 December 2013

Proctitis Treatments – Radiation proctitis In conventional medicine perspective

Proctitis is defined as a condition of inflammation of the anus and the lining of the rectum (i.e., the distal 10–12 cm) of that can lead to bowl discomfort, bleeding, a discharge of mucus or pus, etc.
VI. Treatments
A. In conventional medicine perspective
Medical treatment of proctitis depends on the etiology
A.1. Radiation proctitis
A.1.1. Acute radiation proctitis
Acute radiation proctitis usually does not require treatment as the diseases can resolve after several months. Topical mesalazine is contraindicated during radiotherapy. Hydrocortisone enema is not superior to sucralfate in preventing acute rectal toxicity.. According to the study to assess whether the topical use of steroids or 5-aminosalicylic acid (5-ASA) is superior to sucralfate in preventing acute rectal toxicity during three-dimensional conformal radiotherapy (3DCRT) to 76 Gy(63),
A.1.2. Chronic radiation proctitis
Chronic radiation proctitis is the result of damage to the blood vessels which supply the colon due to radiotherapy.
1. Non surgical interventions
Chronic radiation proctitis (inflammation of the rectum) may develop after the completion of pelvic radiotherapy. In Studies (preferentially randomised controlled trials) of interventions for the non-surgical management of late radiation proctitis in patients who have undergone pelvic radiotherapy as part of their cancer treatment, indicated that Late radiation complications are a relatively rare manifestation, with many potential carers and poor diagnostic criteria. Although certain interventions look promising and may be effective (such as rectal sucralfate, adding metronidazole to the anti-inflammatory regime and heater probes), single small studies (even if well conducted) provide insufficient evidence(64).
2. Surgical interventions
a. Cryospray Ablation
Radiation proctitis, a common condition associated with radiotherapy for the treatment of pelvic cancers, is characterized by difficult to manage rectal pain and bleeding. According to the study by the Uniformed Services University of the Health Sciences, Cryotherapy is an effective method in the management of chronic radiation proctitis with minimal complications(65).
b. Radio frequency ablation (RFA)
Radiation proctitis is a frequent complication of pelvic radiation for cancer. There is a report of a case of refractory radiation proctitis, with suboptimal response to other therapies, treated successfully with a novel method, radiofrequency ablation(66).
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Sources
(63) http://www.ncbi.nlm.nih.gov/pubmed/12835883
(64) http://www.ncbi.nlm.nih.gov/pubmed/11869662
(65) http://www.ncbi.nlm.nih.gov/pubmed/23362977
(66) http://www.ncbi.nlm.nih.gov/pubmed/23320051