Natural History of Late Radiation Proctosigmoiditis Treated with Topical Sucralfate Suspension

Rectal bleeding due to radiationproctosigmoiditis is often difficult to manage. We hadearlier shown the efficacy of short-term therapy withtopical sucralfate in controlling bleeding in theradiation proctosigmoiditis. We now report our long-termresults with this form of therapy. The study comprised26 patients with radiation proctosigmoiditis.Sigmoidoscopically, 9 (34.6% patients had severechanges, 15 (57.69%) had moderate, and 2 (7.69%) hadmild changes. Severity of bleeding was graded as severe(>15 episodes per week), moderate (8-14 episodes perweek), mild (2-7 episodes per week), negligible (1 episode per week), or nil (no bleeding). Tenpatients had moderate rectal bleeding, while 16 hadsevere bleeding. All patients were treated with 20 ml of10% rectal sucralfate suspension enemas twice a day until bleeding per rectum ceased orfailure of therapy was acknowledged. Response to therapywas considered good whenever the severity of bleedingshowed improvement by a change of two grades. Rectally administered sucralfate achieved good responsein 20 (76.9%) patients at 4 weeks, 22 (84.6%) patientsat 8 weeks, and 24 (92.3%) patients at 16 weeks. Thischange was significant by Wilcoxon matched-pairs signed-ranks test. Two patients requiredsurgery due to poor response. Over a median follow-up of45.5 months (range 5-73 months) after cessation ofbleeding, 17 (70.8%) patients had no further bleeding while 7 (22.2%) had recurrence of bleeding. Allrecurrences responded to short-term reinstitution oftherapy. No treatmentrelated complications wereobserved. Ten patients had other associated latetoxicity due to pelvic irradiation in the form ofasymptomatic rectal stricture (N = 3), rectovaginalfistula (N = 1), intestinal stricture (N = 1), vaginalstenosis (N = 1), and hematuria (N = 6). Three patients had progression of the primary disease in theform of pelvic recurrence (N = 2) and hepatic metastases(N = 1). We conclude that topical sucralfate induces alasting remission in a majority of patients with moderate to severe rectal bleeding due toradiation proctosigmoiditis.