Rectal
bleeding due to radiation
proctosigmoiditis is often difficult to manage. We had earlier shown the efficacy of short-term
therapy with topical
sucralfate in controlling
bleeding in the radiation
proctosigmoiditis. We now report our long-term results with this form of
therapy. The study comprised 26 patients with radiation
proctosigmoiditis. Sigmoidoscopically, 9 (34.6%) patients had severe changes, 15 (57.69%) had moderate, and 2 (7.69%) had mild changes. Severity of
bleeding was graded as severe (> 15 episodes per week), moderate (8-14 episodes per week), mild (2-7 episodes per week), negligible (< or = 1 episode per week), or nil (no
bleeding). Ten patients had moderate rectal
bleeding, while 16 had severe
bleeding. All patients were treated with 20 ml of 10% rectal
sucralfate suspension enemas twice a day until
bleeding per rectum ceased or failure of
therapy was acknowledged. Response to
therapy was considered good whenever the severity of
bleeding showed improvement by a change of two grades. Rectally administered
sucralfate achieved good response in 20 (76.9%) patients at 4 weeks, 22 (84.6%) patients at 8 weeks, and 24 (92.3%) patients at 16 weeks. This change was significant by Wilcoxon matched-pairs signed-ranks test. Two patients required surgery due to poor response. Over a median follow-up of 45.5 months (range 5-73 months) after cessation of
bleeding, 17 (70.8%) patients had no further
bleeding while 7 (22.2%) had recurrence of
bleeding. All recurrences responded to short-term reinstitution of
therapy. No treatment-related complications were observed. Ten patients had other associated late toxicity due to pelvic irradiation in the form of asymptomatic rectal
stricture (N = 3),
rectovaginal fistula (N = 1), intestinal
stricture (N = 1), vaginal
stenosis (N = 1), and
hematuria (N = 6). Three patients had progression of the primary disease in the form of pelvic recurrence (N = 2) and hepatic
metastases (N = 1). We conclude that topical
sucralfate induces a lasting remission in a majority of patients with moderate to severe rectal
bleeding due to radiation
proctosigmoiditis.