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home - Colon - Various Colitides - Radiation Colitis Written by Dr Sebastian Zeki

Radiation Colitis

Radiation ColitisLarge intestine less radiosensitive than small intestine.Looks like an IBD-like pancolitis.Prior pelvic irradiation is also associated with an increased risk of rectal cancer in subsequent years. Diagnostic Features:-Pallor with friability.-Telangiectasias, which can be multiple, large, and serpiginous.-Changes can be patchy or continuous. Treatments for Bleeding:A trial of sucralfate enema therapy.APCFormalin application may reduce the need for recurrent endoscopy.Formaldehyde- induces coagulative tissue necrosis on contact. Can irritate anoderm -Argon plasma coagulation- Shows improvement in bleeding and anaemia after av 2.9 sessions.-Lasers- also effective- Argon and Nd:YAG laser have been used to coagulate bleeding ectatic vessels throughout the GI tract.-Bipolar and heater probe- can be effective.-Surgery- only for people with intractable symptoms. Symptoms:DiarrheaRectal urgency or tenesmus Bleeding (rare) Acute radiation injury occurs during and within six weeks of therapy. Acute radiation injury is caused by direct mucosal damage from radiation exposure and usually resolves after radiation is discontinued , although some patients report persistent symptoms for at least one year. Butyrate enemas may accelerate healing. 9 to 14m following radiation exposure, up to 30yrs Late radiation injury is due to progressive epithelial atrophy and fibrosis associated with obliterative endarteritis and chronic mucosal ischemia. Symptoms:-Diarrhoea.-Obstructed defaecation (in patients who have developed strictures).-Bleeding.-Rectal pain.-Urgency.-Faecal incontinence. Acute Chronic Use 4 % formalin-soaked gauze to the affected areas in the rectum via a rigid sigmoidoscope for as long as was required to achieve hemostasis. Effective in 73-93% (make sure have full bowel prep or colonic gas can cause explosion) Preventative medications:Amifistone.Sulphasalazine. Other Treatments:Sulfasalazine and aminosalicylates- anecdotal evidence otherwise disappointing.Hormonal therapy. Benefit shown in one case series but side effects remain an issue.Hyperbaric oxygen- expensive and high drop out rate but significant improvement (89 vs 63% controls).Vitamin A (oral retinol palmitate)- potential role. Treatment for obstructive symptoms:Stool softeners for mild obstructive symptoms.Dilation- if strictured. Treatments for tenesmus and rectal pain:Sucralfate- reported improvement in 92% by 16 weeks- this has no proven role in prevention.Short-chain fatty acid enemas- this is not useful.Pentosan polysulfate (heparin-like compound)- this is not useful.Metronidazole may have a role but only 1 study to support it.Antioxidants- Vitamin E (400 IU tds) and vitamin C (500 mg tds) are associated with improvement in diarrhoea and urgency-further trials Treatment may not be needed in mild bleeding (stops spontaneously within 6months in 35%) -Only role of biopsies is to rule out other conditions (eg IBD).-Biopsies over the prostate can cause fisulisation so take from posterior and lateral walls to avoid the irradiated areas. Radiation Proctitis Written by Dr Sebastian Zeki Late Complications:Increased colorectal cancer risk 10 years after radiation.Further risk of urethrosigmoid fistulas.

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