Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C

OBJECTIVE: Chronic radiation proctitis, a common sequelae of pelvic radiati on, is characterized by obliteration of the submucosal vasculature with sub sequent ischemia and reperfusion injury. Oxidative stress is thought to be a major mechanism in radiation proctitis. Therefore. antioxidants (vitamins E and C) may be beneficial. METHODS: Twenty consecutive symptomatic outpatients with endoscopically doc umented radiation proctitis seen in a single gastroenterology clinic were g iven a combination of vitamin E (400 IU tid) and vitamin C (500 mg tid). Pr evious radiation therapy was given for prostatic (n = 10) or gynecological (n = 10) malignancies. These patients presented with one or more of the fol lowing symptoms: rectal bleeding, rectal pain, diarrhea, or fecal urgency. Using a questionnaire, these symptoms were rated by the patients in terms o f their severity (grade 0-4) and frequency (grade 0-4) before and after tre atment with vitamins E and C. A symptom index was calculated by the additio n of the severity and frequency scores (8 = most symptomatic). The lifestyl e impact of the symptoms was also assessed by questionnaire grading from 0 (no effect on daily activity) to 4 (afraid to leave home). Among these 20 p atients, 10 patients who received vitamins E and C for 1 yr were assessed a gain to determine whether their initial responses were sustained. RESULTS: There was a significant (p < 0.05: Wilcoxon rank) improvement in t he symptom index (before treatment vs after treatment with vitamins E and C ) for bleeding (median score: 4 vs 0), diarrhea (median score: 5 vs 0), and urgency (median score: 6 vs 3). Patients with rectal pain did not improve significantly. Bleeding resolved in four of 11 patients, diarrhea resolved in eight of 16 patients, fecal urgency resolved in three of 16 patients, an d rectal pain resolved in two of six patients. Lifestyle improved in 13 pat ients, including seven patients who reported a return to normal. Two of the patients with no improvement in their daily symptoms also had radiation il eitis. All 10 patients who underwent a second follow-up interview reported sustained improvement in their symptoms 1 yr later. CONCLUSION: A substantial number of patients with radiation proctitis seem to benefit from antioxidant therapy. A double-blind placebo-controlled tria l is needed to confirm this open-labeled pilot study. (Am J Gastroenterol 2 001;96: 1080-1084. (C) 2001 by Am. Coll. of Gastroenterology).