Management of GI Side-effects
Table of Contents

Proctitis

When the cause is radiation therapy or is unknown, anti-inflammatory drugs such as hydrocortisone or mesalamine1 may provide relief. Both hydrocortisone and can be administered as either an enema or a suppository. Mesalamine and other anti-inflammatory drugs, such as sulfasalazine2 and olsalazine3, may be taken by mouth at the same time that drugs are administered rectally, for added benefit. If these forms of treatment do not relieve the inflammation, formalin can be applied directly to the area or oral corticosteroids may be used. Laser or Argon plasma coagulation has also been used.

Misoprostol given as a once-daily suppository did not decrease the incidence and severity of radiation-induced acute proctitis and may increase the incidence of acute bleeding. The results of this study do not support the use of sucralfate administered rectally as a method for reducing the late toxicity of nonconformal RT for prostate cancer.[2]

2250 mg of balsalazide (Colazal) BID 5 days before RT and continuing for 2 weeks after completion.[1]

Bibliography
1. Jahraus CD, Bettenhausen D, Malik U, Sellitti M, St Clair WH. Prevention of acute radiation-induced proctosigmoiditis by balsalazide: a randomized, double-blind, placebo controlled trial in prostate cancer patients. Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1483-7. Epub 2005 Aug 15. PMID: 16099600
2. O'Brien PC, Franklin CI, Poulsen MG, Joseph DJ, Spry NS, Denham JW. Acute symptoms, not rectally administered sucralfate, predict for late radiation proctitis: longer term follow-up of a phase III trial—Trans-Tasman Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2002 Oct 1;54(2):442-9. PMID: 12243820
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