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Short-chain fatty acids in the treatment of radiation proctitis

A randomized, double-blind, placebo-controlled, cross-over pilot trial

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Treatment of chronic radiation proctitis remains unsatisfactory. Short-chain fatty acids are the preferred energy source for the colonic epithelium. We aimed to determine for the first time whether topical butyric acid enemas relieve symptoms and improve the macroscopic and microscopic findings in chronic radiation proctitis. METHODS: A randomized, double-blind, placebo-controlled, cross-over pilot trial compared patients given two weeks of butyric acid enemas (40 mmol) twice per day with those given placebo, with a one-week washout period; 15 patients were randomized and 12 completed both arms of the trial. A total symptom score combined six symptom items per week (rectal pain, episodes of rectal bleeding, amount of blood passed, days with diarrhea, number of stools, and urgency). Symptom, endoscopic, and histologic scores were obtained at the beginning of the study and again at the last week of each treatment arm. RESULTS: Total symptom score at baseline (median, 5.5) improved for those patients receiving active treatment (median, 3.5), but compared with placebo (median, 4.5), the change was not significant. Endoscopic appearances were largely unaltered by active treatment. Histology was abnormal in 82 percent of patients receiving placebo compared with 55 percent of those given butyric acid enemas (P=not significant). CONCLUSION: Butyric acid enemas do not appear to be superior to placebo in the treatment of chronic radiation proctitis.

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References

  1. Earnest DL, Trier JS. Radiation enteritis and colitis. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal disease: pathophysiology, diagnosis, management. 5th ed. WB Saunders, Philadelphia, 1993:1257–70.

    Google Scholar 

  2. Scheppach W, Somer H, Kirchner T,et al. Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis. Gastroenterology 1992;103:51–6.

    PubMed  Google Scholar 

  3. De Silva H, Ireland A, Kettlewell M, Mortensen N, Jewel D. Short-chain fatty acid irrigation in severe pouchitis. N Engl J Med 1989;321:1416–7.

    Google Scholar 

  4. Harig JM, Soergel KH, Komorowski RA, Wood CM. Treatment of diversion colitis with short chain-fatty acid irrigation. N Engl J Med 1988;320:23–8.

    Google Scholar 

  5. Pilepich M, Krall J, George F,et al. Treatment related morbidity in phase 3 RTOG studies in extended-field irradiation for carcinoma of the prostate. Int J Radiat Oncol Biol Phys 1984;10:1861–7.

    PubMed  Google Scholar 

  6. Kline J, Buchler D, Boone M. The relationship of reactions to complications in the radiation therapy of cancer of the cervix. Radiology 1972;105:413–6.

    PubMed  Google Scholar 

  7. Hurtig A. Local hydrocortisone acetate for radiation proctitis. J Postgrad Med 1954;15:37–9.

    Google Scholar 

  8. Golstein F, Khoury J, Thorton J. Treatment of chronic radiation enteritis and colitis with salicylazopyridine and systemic corticosteroids. Am J Gastroenterol 1976;65:201–8.

    PubMed  Google Scholar 

  9. Grigsby P, Pilepich M, Parsons C. Preliminary results of a phase 1/2 study of sodium pentosanpolysulfate in the treatment of chronic radiation-induced proctitis. Am J Clin Oncol 1990;13:28–31.

    PubMed  Google Scholar 

  10. Kochhar R, Sharma S, Gupta B, Metha SK. Rectal sucralfate in radiation proctitis [letter]. Lancet 1988;2:400.

    Google Scholar 

  11. McElligot E, Quigley C, Hanks G. Transexamic acid and rectal bleeding [letter]. Lancet 1988;2:431.

    PubMed  Google Scholar 

  12. Buchi K, Dixon J. Argon laser treatment of haemorrhagic radiation proctitis. Gastrointest Endosc 1987;33:27–30.

    PubMed  Google Scholar 

  13. Charneau J, Bouachour G, Person B, Burton P, Ronceray J, Boxer J. Severe hemorrhagic radiation proctitis advancing to gradual cessation with hyperbaric oxygen. Dig Dis Sci 1991;36:373–5.

    PubMed  Google Scholar 

  14. Seow-Choen F, Goh H, Eu K, Ho Y-H, Tay S-K. A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum 1993;36:135–8.

    PubMed  Google Scholar 

  15. Anseline P, Lavery I, Fazio V, Jazelman D, Weakley F. Radiation injury of the rectum: evaluation of surgical treatment. Ann Surg 1981;194:716–24.

    PubMed  Google Scholar 

  16. Marks G, Mohiudden M. The surgical management of radiation-injured intestine. Surg Clin North Am 1983;63:81–96.

    PubMed  Google Scholar 

  17. Jao S, Beart R, Gunderson L. Surgical treatment of radiation injuries of the colon and rectum. Am J Surg 1986;151:272–7.

    PubMed  Google Scholar 

  18. Russell J, Welch J. Operative management of radiation injuries of the intestinal tract. Am J Surg 1979;137:433–42.

    PubMed  Google Scholar 

  19. Allen-Mersh TG, Wilson EJ, Hope-Stone H, Mann CV. The management of late radiation induced rectal injury after treatment of carcinoma of the uterus. Surg Gynecol Obstet 1987;164:521–4.

    PubMed  Google Scholar 

  20. Cunningham I. The management of radiation proctitis. Aust N Z J Surg 1980;50:172–8.

    PubMed  Google Scholar 

  21. Haboubi N, Schofield P, Rowland P. The light and electron microscopic features of early and late phase radiation-induced proctitis. Am J Gastroenterol 1988;83:114–4.

    PubMed  Google Scholar 

  22. Kwitko SP, Pieterse A, Hecker R, Rowland R, Wigg D. Chronic radiation injury to the intestine: a clinicopathological study. Aust N Z J Med 1982;12:272–7.

    PubMed  Google Scholar 

  23. Gal D, Strickland D, Lifshitz S, Buchsbaum HJ, Mitchell MD. Effect of radiation on prostaglandin production by human bowelin vitro. Int J Radiat Oncol Biol Phys 1984;10:653–7.

    PubMed  Google Scholar 

  24. Thomson A, Cheeseman C, Walker K. Intestinal uptake of bile acids: effect of external abdominal irradiation. Int J Radiat Oncol Biol Phys 1984;10:671–85.

    PubMed  Google Scholar 

  25. Sedgwick D, Howard G, Ferguson A. Pathogenesis of acute radiation injury to the rectum: a prospective study in patients. Int J Colorectal Dis 1994;9:23–30.

    PubMed  Google Scholar 

  26. Roediger W. Role of anaerobic bacteria in the metabolic welfare of the colonic mucosa in man. Gut 1980;21:793–8.

    PubMed  Google Scholar 

  27. Rolandelli R, Koruda M, Settle R. Effects of intraluminal infusion of short-chain fatty acids on the healing of colonic anastomoses in the rat. Surgery 1986;100:198–204.

    PubMed  Google Scholar 

  28. Kvietys P, Granger D. Effect of volatile fatty acids on blood flow and oxygen uptake by the dog colon. Gastroenterology 1981;80:962–9.

    PubMed  Google Scholar 

  29. Kollmorgen C, Meagher A, Wolff B, Pemberton J, Martenson J, Illstrup D. The long-term effect of postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;5:676–82.

    Google Scholar 

  30. Babb RR. Radiation proctitis. Am J Gastroenterol 1996;91:1309–11.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, St George Hospital, Kogarah, Australia

    Frank Chen F.R.A.C.S. & Denis King F.R.A.C.S.

  2. Department of Medicine, University of Sydney, Nepean Hospital, 2751, Penrith, New South Wales, Australia

    Nicholas A. Talley F.R.A.C.P. (Professor of Medicine), Michael Jones Ph.D. & Nicholas J. Talley M.D.

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  1. Nicholas A. Talley F.R.A.C.P.
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  2. Frank Chen F.R.A.C.S.
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  3. Denis King F.R.A.C.S.
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  4. Michael Jones Ph.D.
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  5. Nicholas J. Talley M.D.
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Talley, N.A., Chen, F., King, D. et al. Short-chain fatty acids in the treatment of radiation proctitis. Dis Colon Rectum 40, 1046–1050 (1997). https://doi.org/10.1007/BF02050927

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