The Efficacy of the Combination Therapy with Oral and Topical Mesalazine for Patients with the First Episode of Radiation Proctitis

• Published in: Digestive diseases and sciences Vol. 56; no. 9; pp. 2672 - 2677
• Main Authors: Seo, Eun Hee, Kim, Tae Oh, Kim, Tae Gyoon, Joo, Hee Rin, Park, Jongha, Park, Seung Ha, Yang, Sung Yeon, Moon, Young Soo, Park, Min Jae, Ryu, Dong Yup, Song, Geun Am
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2011; Springer; Springer Nature B.V
• Subjects: Administration, Oral; Administration, Topical; Aged; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biochemistry; Biological and medical sciences; Care and treatment; Digestive system. Abdomen; Endoscopy; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hemorrhage - etiology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Mesalamine; Mesalamine - administration & dosage; Mesalamine - therapeutic use; Middle Aged; Oncology; Original Article; Other diseases. Semiology; Pelvic Neoplasms - radiotherapy; Proctitis; Proctitis - etiology; Radiation; Radiation Injuries - drug therapy; Radiotherapy; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Suppositories; Transplant Surgery; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Efficacy; Radiation proctitis; Colonoscopy; 5-ASA; Prostaglandin-endoperoxide synthase; Local administration; Proctitis; Gastroenterology; Intestinal disease; Salicylates; Endoscopy; Anorectal disease; Human; Drug combination; Enzyme; Oral administration; Enzyme inhibitor; Metabolic diseases; Non steroidal antiinflammatory agent; Analgesic; Mesalazine; Antipyretic; Digestive diseases; Combined treatment; Oxidoreductases
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-011-1637-7

Background/Aims
Radiation proctitis is a common complication of pelvic radiation for which an optimal treatment remains undetermined. We assessed the efficacy of oral and topical mesalazine combination therapy for patients with naive radiation proctitis.
Methods
A total of 23 patients with radiation proctitis were enrolled in the study over a period of 2 years. Three of these patients were excluded due to severe bleeding during the study. Twenty patients (mean age 60.3 years; two males, 18 females) were treated with oral mesalazine (3 × 1 g per day) plus a daily mesalazine suppository (1 g per day at bedtime) for 4 weeks. The efficacy of treatment was assessed according to the Subjective Objective Management Analytic (SOMA) scale for alleviation of clinical symptoms of rectal toxicity and sigmoidoscopic findings.
Results
The mean bleeding score improved significantly from 2.10 to 1.70 (
p
 = 0.002) with mesalazine treatment. However, scores were not improved for pain (0.30–0.20,
p
 = 0.163), tenesmus (0.50–0.45,
p
 = 0.577), or stool frequency (0.35–0.30,
p
 = 0.577). The improvements in the mean telangiectasia score (1.80–1.45,
p
 = 0.005), bleeding point score (1.60–1.05,
p
 < 0.001), and friable mucosa score (1.35–1.00,
p
 = 0.005) were all statistically significant. No side-effects were noted in any of the patients.
Conclusions
The combination of oral and topical mesalazine therapy for radiation proctitis may be a safe and effective treatment for naive radiation proctitis, especially for hemorrhagic proctitis. A large, randomized controlled trial is required to confirm the results of this pilot study.