Mesalazine suppository for the treatment of refractory ulcerative chronic radiation proctitis

Abstract

The aim of the present study was to investigate the safety and efficacy of mesalazine suppository in the treatment of refractory ulcerative chronic radiation proctitis (CRP). In total, 10 refractory ulcerative CRP patients who did not respond to previous medical treatments were recruited for the present study and were treated with mesalazine suppository (0.5 g) twice daily for 24 weeks. For each patient, the severity of clinical symptoms and endoscopic appearance was assessed before and after the treatment. For symptom scoring, the reductions in the mean total symptom score (pre- vs. post-treatment, 8.20 vs. 0.90; P<0.01), rectal bleeding score (2.40 vs. 0.30; P<0.01), rectal pain score (2.00 vs. 0.50; P<0.01), stool frequency score (2.00 vs. 0.10; P<0.01) and tenesmus score (1.80 vs. 0.00; P<0.01) were all statistically significant. For mucosal damage scoring, there was a reduction in the mean scores for total scores (9.22 vs. 5.22; P<0.01), telangiectasia (2.78 vs. 1.89; P=0.009), edema (2.89 vs. 1.78; P=0.001) and ulceration (2.44 vs. 0.89; P=0.003). However, statistically reductions in the median symptom scores were not observed for stenosis (0.78 vs. 0.67; P=0.347) and necrosis (0.33 vs. 0.00; P=0.081). Furthermore, no adverse events were observed during and after the treatment. The topical mesalazine suppository may be a safe and effective treatment for CRP, particularly for patients with deep ulcers. Adequately randomized controlled trials are required to confirm the results of the present study.

Therapeutics in Radiation-induced Proctopathy: A Systematic Review

“…28,29 The excellent response of patients with colitis undergoing treatment with 5-ASA derivatives led to the attempt of also prescribing the therapy for patients with radiotherapy-induced proctopathy. 24,30,31 The use of 5-ASA derivatives is based on the increase in IL-2, IL-6 and IL-8, both in cases of inflammatory bowel diseases and radiotherapyinduced proctopathy. 26 The most commonly used mesalazine compound has a formulation that dissolves when the pH 7, thereby acting from the ileum.…”

“…The combination of oral and topical therapies with these compounds could lead to a satisfactory response in the treatment of radiation-induced proctopathy. 8 Wu et al 31 treated patients with rectal ulceration due to radiation-induced proctopathy who did not respond to other clinical treatments with a suppository containing 0.5 g of mesalazine, twice daily, for 6 months, with improvement of the symptoms of bleeding, tenesmus, evacuation frequency, and rectal pain. With this study, the authors 31 showed that the mesalazine suppository can be a viable option in the treatment of refractory cases of acute radiation proctitis (ARP), with the need for further studies.…”

Administration of modified Gegen Qinlian decoction for hemorrhagic chronic radiation proctitis: A case report and review of literature

“…The most common symptoms of CRP are rectal bleeding, also called hemorrhagic CRP, due to neoangiogenesis and vascular ectasias[ 3 , 5 , 6 ]. Rectal ulcer is another symptom of CRP, which may lead to severe complications, such as perforation, fistulas, strictures, or even death, seriously affecting a patient’s quality of life[ 7 , 8 ].…”

Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation

“…Under endoscopy, CRP is characterized by mucosal fragility, pallor, spontaneous bleeding, telangiectasias, mucosal edema, strictures, fistulas, and ulcerations [ 7 , 8 ]. Rectal ulcer is a common complication of CRP, persistent and gradually deteriorating ulcer will lead to severe complications, such as perforation, necrosis, abscess, fistulas, strictures, or even death, seriously impairing patients’ quality of life [ 5 , 9 ]. In further, due to radiotherapy, the ulcer of CRP patients has a poor wound healing [ 10 ].…”