Skip to main content
SpringerLink
Log in

Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis

Randomized, double-blind, controlled trial

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Short chain fatty acids are the main energy source of coloncytes and their use may be impaired in chronic radiation proctitis. The aim of the present study was to evaluate the therapeutic effect of short chain fatty acid enemas in patients with chronic radiation proctitis. METHODS: A prospective, randomized, double-blind trial comparing short chain fatty acid enemas with placebo was conducted in 19 patients with chronic radiation proctitis. Short chain fatty acid enemas contained 60 mM sodium acetate, 30 mM sodium propionate, and 40 mM sodium butyrate. The treatment period lasted five weeks and patients were followed up for six months. RESULTS: On admission, both groups were similar regarding all parameters evaluated. After five weeks short chain fatty acid-treated patients showed a significant decrease in the number of days with rectal bleeding from the previous week (4.4±1.8 to 1.4±2.2;P=0.001) and an improvement of endoscopic score (4.8±1.4 to 2.2±1.2;P=0.001). Hemoglobin values were also significantly higher in short chain fatty acid-treated patients (13.1±0.9 g/dlvs. 10.7±2.1 g/dl;P=0.02). Mucosal DNA and protein concentrations decreased in both groups but significantly so only in placebotreated patients (P=0.05). Changes in histologic parameters were not significant in either group. Although short chain fatty acid-treated patients did not get worse in the next six months, placebo-treated ones gradually improved, and at the end of six months, differences between the two groups were no longer observed. CONCLUSIONS: Short chain fatty acid enemas can accelerate the process of healing in chronic radiation proctitis, but treatment has to be continuous if a complete and sustained clinical, endoscopic, and histologic response is to be obtained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cummings JH, Macfarlane GT. The control and consequences of bacterial fermentation in the colon. J Appl Bacteriol 1991;70:443–59.

    PubMed  Google Scholar 

  2. Mortensen PB, Hove H, Clausen MR, Holtug K. Fermentation to short-chain fatty acids and lactate in human faecal batch cultures. Intra and inter-individual variations versus variations caused by changes in fermented saccharides. Scand J Gastroenterol 1991;26:1285–94.

    PubMed  Google Scholar 

  3. Clausen MR, Mortensen PB. Kinetic studies on the metabolism of short-chain fatty acids and glucose by isolated rat colonocytes. Gastroenterology 1994;106:423–32.

    PubMed  Google Scholar 

  4. Binder HJ, Mehta P. Short chain fatty acids stimulate active sodium and chloride absorption in vitro in the rat distal colon. Gastroenterology 1989;96:989–96.

    PubMed  Google Scholar 

  5. McNeil NI. The contribution of the large intestine to energy supplies in man. Am J Clin Nutr 1984;39:338–42.

    Google Scholar 

  6. Mortensen FV, Hessov I, Birke H, Korsgaard N, Nielson H. Microcirculatory and trophic effects of short chain fatty acids in the human rectum after Hartmann's procedure. Br J Surg 1991;78:1208–11.

    PubMed  Google Scholar 

  7. Mortensen FV, Nielsen H, Mulvany MJ, Hessov I. Short chain fatty acids dilate isolated human colonic resistance arteries. Gut 1990;31:1391–4.

    PubMed  Google Scholar 

  8. D'Argenio G, Cosenza V, Sorrentini I,et al. Butyrate, mesalamine and factor XIII in experimental colitis in the rat: Effects on transglutaminase activity. Gastroenterology 1994;106:399–404.

    PubMed  Google Scholar 

  9. Roediger WE, Moore A. The effect of short chain fatty acids on sodium absorption in isolated human colon perfused through the vascular bed. Dig Dis Sci 1981;26:100–6.

    Article  PubMed  Google Scholar 

  10. Scheppach W, Bartram P, Richter A,et al. Effect of short-chain fatty acids on the human colonic mucosain vitro. J Parenter Enter Nutr 1992;16:43–8.

    Google Scholar 

  11. Sakata T. Stimulatory effect of short-chain fatty acids on epithelial cell proliferation in the rat intestine: a possible explanation for trophic effects of fermentable, gut microbes and luminal trophic factors. Br J Nutr 1987;58:95–103.

    Article  PubMed  Google Scholar 

  12. Frankel WL, Zhang W, Singh A,et al. Mediation of the trophic effects of short chain fatty acids on the rat jejunum and colon. Gastroenterology 1994;106:375–80.

    PubMed  Google Scholar 

  13. Scheppach W, Sommer 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 

  14. Steinhart AH, Brzezinski A, Baker JP. Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas. Am J Gastroenterol 1994;89:179–83.

    Google Scholar 

  15. Wischmeyer P, Pemberton JH, Phillips SF. Chronic pouchitis after ileal pouch-anal anastomosis: responses to butyrate and glutamine suppositories in a pilot study. Mayo Clin Proc 1993;68:978–81.

    PubMed  Google Scholar 

  16. Harig JM, Soergel KH, Komorowski RA, Wood CM. Treatment of diversion colitis with short-chain fatty acid irrigation. N Engl J Med 1989;320:23–8.

    PubMed  Google Scholar 

  17. Deitel M, To TB. Major intestinal complications of radiotherapy: management and nutrition. Arch Surg 1987;122:1421–4.

    PubMed  Google Scholar 

  18. Berthrong M. Pathologic changes secondary to radiation. World J Surg 1986;10:155–70.

    Article  PubMed  Google Scholar 

  19. Fisher L, Kimose HH, Spjeldnaes N, Wara P. Late progress of radiation-induced proctitis. Acta Chir Scand 1990;156:801–5.

    PubMed  Google Scholar 

  20. Sher ME, Bauer J. Radiation-induced enteropathy. Am J Gastroenterol 1990;85:121–8.

    PubMed  Google Scholar 

  21. Baum CA, Biddle WL, Miner PB. Failure of 5-Aminosalicylic Acid enemas to improve chronic radiation proctitis. Dig Dis Sci 1989;34:758–60.

    Article  PubMed  Google Scholar 

  22. Kochhar R, Patel F, Dhar A,et al. Radiation-induced proctosigmoiditis: prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci 1991;36:103–7.

    Article  PubMed  Google Scholar 

  23. Pourquier H, Dubois JB, Delard R. Cancer of the uterine cervix: dosimetric guidelines for prevention of the late rectal and rectosigmoid complication as a result of radiotherapeutic treatment. Int J Radiat Oncol Biol Phys 1982;8:1887–95.

    PubMed  Google Scholar 

  24. Cattoretti G, Becker M, Key G,et al. Monoclonal antibodies against recombinant parts of Ki-67 antigen (MIB 1 and MIB 3) detect proliferating cells in microwave-processed formalin-fixed paraffin sections. J Pathol 1992;168:357–63.

    Article  PubMed  Google Scholar 

  25. Prasad AS, DuMouchelle E, Koniuch D, Oberleas D. A simple fluorometric method for the determination of RNA and DNA in tissues. J Lab Clin Med 1972;80:598–602.

    PubMed  Google Scholar 

  26. Sedmak JJ, Grossberg SE. A rapid, sensitive, and versatile assay for protein using coomassie brilliant blue G250. Anal Biochem 1977;79:544–52.

    Article  PubMed  Google Scholar 

  27. Midões-Correia J, Pinto A, Dias-pereira A, Nobre-Leitão C, Costa-Mira F. Successful treatment of hemorrhagic radiation proctitis with formalin irrigation [abstract]. Gastroenterology 1994;106(Suppl 4):A254.

    Google Scholar 

  28. al-Sabbagh R, Sinicrope FA, Sellin JH, Shen Y, Roubein L. Evaluation of short-chain fatty acids enemas: treatment of radiation colitis. Am J Gastroenterol 1996;91:1814–6.

    PubMed  Google Scholar 

  29. Mamel JJ, Chen M, Combs W,et al. Short-chain fatty acids (SCFA) enemas are useful for the treatment of chronic radiation proctitis [Abstract]. Gastroenterology 1995;108:A305.

    Google Scholar 

  30. Whitehead RH, Young GP, Bhatal PS. Effects of short chain fatty acids on a new human colon carcinoma cell line (LIM 1215). Gut 1986;27:1457–63.

    PubMed  Google Scholar 

  31. Hass R, Busche R, Luciano L, Reale E, von Englhardt W. Lack of butyrate is associated with induction of Bax and subsequent apoptosis in the proximal colon of guinea pig. Gastroenterology 1997;112:875–81.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Serviço de Gastrenterologia, Lsboa, Portugal

    Anabela Pinto M.D., Paulo Fidalgo M.D., Marília Cravo M.D., Ph.D., Jaime Midões M.D. & Carlos Nobre Leitão M.D., Ph.D.

  2. Serviço Patologia Morfológica, Lisboa, Portugal

    Paula Chaves M.D. & Joaninha Rosa M.D.

  3. Centro de Investigação de Patobiologia Molecular, Portugal

    Marília Cravo M.D., Ph.D.

  4. Farmácia do Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal

    Maria dos Anjos Birto M.D.

Authors
  1. Anabela Pinto M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paulo Fidalgo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marília Cravo M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaime Midões M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paula Chaves M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joaninha Rosa M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria dos Anjos Birto M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos Nobre Leitão M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Pinto, A., Fidalgo, P., Cravo, M. et al. Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis. Dis Colon Rectum 42, 788–795 (1999). https://doi.org/10.1007/BF02236937

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02236937

Key words

Search

Navigation