Radiation proctocolitis: Difference between revisions
No edit summary |
ClaireLewis (talk | contribs) |
||
| (4 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum. | * Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum. | ||
* Acute ( up to three months), Chronic ( 3 months to years later) | |||
*Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate. | *Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate. | ||
==Clinical Features== | ==Clinical Features== | ||
===Uncomplicated=== | ===Uncomplicated=== | ||
*Diarrhea | *[[Diarrhea]] | ||
*Urgency | *Urgency | ||
*Mucus discharge | *Mucus discharge | ||
*Tenesmus | *Tenesmus | ||
* | *[[GI bleeding]] is more common in chronic radiation proctitis than acute radiation proctitis | ||
===Complicated=== | ===Complicated=== | ||
*Radiation injury extending to genitourinary system | *Radiation injury extending to genitourinary system | ||
**urethral stenosis | **urethral stenosis | ||
**Cystitis | **[[Cystitis]] | ||
**Ureteral scarring | **Ureteral scarring | ||
*Radiation injury extending to small bowel | *Radiation injury extending to small bowel | ||
**Small bowel obstruction | **[[Small bowel obstruction]] | ||
**Small intestine bacterial overgrowth | **Small intestine bacterial overgrowth | ||
**Fistulae | **Fistulae | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* | *[[Inflammatory bowel disease]] | ||
*[[Infectious colitis]] | |||
* | |||
*Diversion colitis | *Diversion colitis | ||
*Ischemic colitis | *[[Ischemic colitis]] | ||
* | *[[Diverticulitis]] | ||
* | *Chronic [[graft-versus-host disease]] | ||
==Evaluation== | ==Evaluation== | ||
| Line 42: | Line 39: | ||
*Endoscopy and biopsy | *Endoscopy and biopsy | ||
**Nonspecific findings | **Nonspecific findings | ||
**Pallor, friability | **Pallor, friability, ulcerations, bleeding | ||
**Telangiectatic | **Telangiectatic with bleeding | ||
**Avoid | **Avoid biopsy unless malignancy is suspected as facilitate fistula/non healing wound formation | ||
*Imaging | *Imaging | ||
**CT if obstructive symptoms are present | **CT if obstructive symptoms are present | ||
**MRI if suspicion is high for radiation-induced fistulae | **MRI if suspicion is high for radiation-induced fistulae | ||
==Management== | ==Management== | ||
| Line 54: | Line 51: | ||
*Generally self-limited | *Generally self-limited | ||
*approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover | *approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover | ||
*Hydration, steroids, +/- 5-aminosalicylate enema. | *Hydration, [[steroids]], +/- 5-aminosalicylate enema, bowel regimen. | ||
===Chronic=== | ===Chronic=== | ||
*Non-invasive | *Non-invasive | ||
** | **Anti-inflammatories | ||
** | **Sucralfate enema | ||
**short-chain fatty acids | **short-chain fatty acids | ||
**Hyperbaric O2 | **Hyperbaric O2 | ||
**Antioxidants | **Antioxidants: Vitamin A, E, C. | ||
*Invasive | *Invasive<ref>Vanneste BGL, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Disease. 2015;30:1293-1303. doi:10.1007/s00384-015-2289-4.</ref> | ||
**ablation | **Endoscopic treatment with ablation therapy : Topical formalin, Laser, Argon plasma coagulation | ||
** | **Surgical resection last resort | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 17:50, 17 August 2019
Background
- Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum.
- Acute ( up to three months), Chronic ( 3 months to years later)
- Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate.
Clinical Features
Uncomplicated
- Diarrhea
- Urgency
- Mucus discharge
- Tenesmus
- GI bleeding is more common in chronic radiation proctitis than acute radiation proctitis
Complicated
- Radiation injury extending to genitourinary system
- urethral stenosis
- Cystitis
- Ureteral scarring
- Radiation injury extending to small bowel
- Small bowel obstruction
- Small intestine bacterial overgrowth
- Fistulae
Differential Diagnosis
- Inflammatory bowel disease
- Infectious colitis
- Diversion colitis
- Ischemic colitis
- Diverticulitis
- Chronic graft-versus-host disease
Evaluation
- Labs
- Stool C.diff toxin along with routine stool cultures
- Specific testing for E.coli 0157:H7
- Ova and Parasite assay including giardia
- CBC, electrolytes, albumin, ESR, CRP
- Endoscopy and biopsy
- Nonspecific findings
- Pallor, friability, ulcerations, bleeding
- Telangiectatic with bleeding
- Avoid biopsy unless malignancy is suspected as facilitate fistula/non healing wound formation
- Imaging
- CT if obstructive symptoms are present
- MRI if suspicion is high for radiation-induced fistulae
Management
Acute
- Generally self-limited
- approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover
- Hydration, steroids, +/- 5-aminosalicylate enema, bowel regimen.
Chronic
- Non-invasive
- Anti-inflammatories
- Sucralfate enema
- short-chain fatty acids
- Hyperbaric O2
- Antioxidants: Vitamin A, E, C.
- Invasive[1]
- Endoscopic treatment with ablation therapy : Topical formalin, Laser, Argon plasma coagulation
- Surgical resection last resort
Disposition
- Treat outpatient
- Severe cases that are candidates for surgery should be admitted
See Also
External Links
References
- ↑ Vanneste BGL, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Disease. 2015;30:1293-1303. doi:10.1007/s00384-015-2289-4.