Management of radiation proctotis

Management of radiation proctitis involves a combination of diagnostic assessment and tailored therapeutic interventions aimed at symptom relief and mucosal healing.

Initial specialist assessment typically includes sigmoidoscopy to confirm the diagnosis, evaluate the extent of mucosal injury, and exclude other causes such as inflammatory bowel disease or malignancy NICE CKS.

Conservative management focuses on symptom control and may include dietary modifications to ensure adequate fibre and fluid intake, which can help manage bowel symptoms NICE CKS.

Pharmacological treatment options include topical therapies such as sucralfate enemas or mesalazine, which have been used to promote mucosal healing and reduce inflammation Sarin & Safar 2013. Oral and topical aminosalicylates may be considered, drawing from their use in inflammatory proctitis, although evidence is limited NICE CKS.

For patients with bleeding or persistent symptoms, endoscopic therapies such as argon plasma coagulation can be employed to control bleeding and promote mucosal repair Sarin & Safar 2013.

In refractory cases, hyperbaric oxygen therapy has shown benefit by enhancing tissue oxygenation and healing, although availability may be limited Sarin & Safar 2013.

Severe or complicated radiation proctitis may require surgical intervention, but this is reserved for cases unresponsive to medical and endoscopic treatments NICE CKS.

Throughout management, multidisciplinary involvement including gastroenterologists, colorectal surgeons, and specialist nurses is important to optimize outcomes and provide supportive care NICE CKS.