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

Pinto, Anabela; Fidalgo, Paulo; Cravo, Marília; Midões, Jaime; Chaves, Paula; Rosa, José; Birto, Maria dos Anjos; Leitão, C. Nobre

doi:10.1007/bf02236937

Cited by 98 publications

(64 citation statements)

References 25 publications

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“…SCFAs cause greater blood flow to the intestinal wall through diminishing the resistance of the arterioles of the colon and rectum. They promote adhesion between the colonocytes, increase sodium and water absorption, stimulate normal growth of the colon epithelial cells, influence motility and favor healing of intestinal wall lesions 15,16,17 . SCFAs play a protective role in relation to neoplasia development because their antiproliferative action interferes in the cell differentiation process, thereby favoring apoptosis 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…They promote adhesion between the colonocytes, increase sodium and water absorption, stimulate normal growth of the colon epithelial cells, influence motility and favor healing of intestinal wall lesions 15,16,17 . SCFAs play a protective role in relation to neoplasia development because their antiproliferative action interferes in the cell differentiation process, thereby favoring apoptosis 17,18 . In segments without intestinal transit, glutamine (a secondary energy substrate for the epithelium that is mainly supplied by the blood) comes to have a primary role and may be used in preference to glucose as an energy source 19 .…”

Section: Discussionmentioning

confidence: 99%

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Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats

et al. 2008

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Purpose:To evaluate histopathological alterations of the colon wall in segments with and without intestinal transit, by computer-assisted imaging, and to correlate these with the length of time diversion. Methods: Thirty male Wistar rats were subjected to intestinal transit diversion by a proximal colostomy and distal mucosa fistula. The animals were divided into three experimental groups according to how long after the initial surgical procedure they were sacrificed: six, twelve and eighteen weeks. Colon segments with and without transit were subjected to histopathological study. The variables colon crypt length, mucosal ulceration, muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria, vascular congestion, number of caliciform cells, inflammatory grade and degree of inflammation, comparing the two colon segments in the different experimental groups were studied. Intestinal crypt length, muscle layer thickness of the mucosa, submucosa and muscularis propria and caliciform cells were measured by computer-assisted imaging method. Mean equality, variance analysis and correlation tests were used in the statistical analysis, and the significance level was set at 5%. Results:Comparison between segments with and without transit showed that the latter presented reduced length of colon crypts and increased muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria. There were greater quantities of ulceration of the mucosal and greater degree of inflammation with increasing time without transit. Mucosal ulceration, submucosal vascular congestion, increased thickness of the submucosal and muscularis propria layers, presence of caliciform cells, inflammatory infiltrate and inflammatory grade correlated significantly with the length of time without transit. Conclusions: Histological alterations occurred in all layers of the colon wall, in the segments without intestinal transit. Ulcerations in the intestinal mucosa, increased number of caliciform cells, greater vascular congestion of the submucosal layer and inflammatory reaction were related to increasing length of time without transit. Key words: Colon. Colitis. Colostomy. Image Processing, Computer-Assisted. Rats. RESUMOObjetivo: Avaliar por método de imagem assistida por computador as alterações histopatológicas da parede cólica em segmentos providos e desprovidos de trânsito intestinal e relacioná-las ao tempo de exclusão. Métodos: Trinta ratos Wistar machos foram submetidos à derivação do trânsito no cólon esquerdo por meio de colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo o sacrifício ter sido realizado seis, doze e dezoito semanas após o procedimento cirúrgico inicial. Segmentos dos cólons providos e desprovidos de trânsito foram submetidos a estudo histopatológico. Foram analisadas as variáveis: comprimento das criptas cólicas, ulceração na mucosa, espessura das camadas muscular da mucosa, submucosa e muscular própria, congestão vascular, número...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats

et al. 2008

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“…53 Several studies of SCFA enemas to promote healing of postradiation mucosal lesions have yielded conflicting results. Initial studies indicated a decrease in rectal bleeding and endoscopic improvements with SCFA use, [54][55][56] but those findings were not reproduced in a subsequent prospective, randomized, double-blind study.…”

Section: Short-chain Fatty Acid Enemasmentioning

confidence: 98%

Late rectal complications after prostate brachytherapy for localized prostate cancer

Phan¹,

Swanson²,

Levy³

et al. 2009

Cancer

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This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Prostate cancer is the leading cause of cancer in men and accounts for approximately 33% of cancer deaths among men in the US.1,2 Management options for organ-confined, low-to intermediate-risk prostate cancer include watchful waiting, radical prostatectomy, external-beam radiation therapy, and prostate brachytherapy with permanent interstitial implants. Recent improvements in radioactive seed implantation techniques have established prostate brachytherapy as a highly effective treatment modality for localized prostate cancer, with long-term local and biochemical control similar to outcomes observed after radical prostatectomy and external-beam radiation therapy. 3,4 Because prostate cancer is diagnosed

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“…Talley et al (1997) was a cross-over study and used a cumulative score encompassing the number of episodes of rectal bleeding per week. Pinto et al (1999) recorded the number of days on which rectal bleeding occurred. Although both sets of cases were scored endoscopically, this is not on the same scale so that the numbers are not comparable.…”

Section: Studies Using Scfa Enemasmentioning

confidence: 99%

Systematic review for non-surgical interventions for the management of late radiation proctitis

et al. 2002

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Chronic radiation proctitis produces a range of clinical symptoms for which there is currently no recommended standard management. The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation proctitis and evaluate the evidence for their efficacy. Synonyms for radiation therapy and for the spectrum of lower gastrointestinal radiation toxicity were combined in an extensive search strategy and applied to a range of databases. The included studies were those that involved interventions for the non-surgical management of late radiation proctitis. Sixtythree studies were identified that met the inclusion criteria, including six randomised controlled trials that described the effects of anti-inflammatory agents in combination, rectal steroids alone, rectal sucralfate, short chain fatty acid enemas and different types of thermal therapy. However, these studies could not be compared. If the management of late radiation proctitis is to become evidence based, then, in view of its episodic and variable nature, placebo controlled studies need to be conducted to clarify which therapeutic options should be recommended. From the current data, although certain interventions look promising and may be effective, one small or modest sized study, even if well-conducted, is insufficient to implement changes in practice. In order to increase recruitment to trials, a national register of cases with established late radiation toxicity would facilitate multi-centre trials with specific entry criteria, formal baseline and therapeutic assessments providing standardised outcome data.

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

Abstract: 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.

Cited by 98 publications

References 25 publications

Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats

Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats

Late rectal complications after prostate brachytherapy for localized prostate cancer

Systematic review for non-surgical interventions for the management of late radiation proctitis

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