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Proctitis Treatment With Hyperbaric Oxygen Therapy

Medical information reviewed by: IONUT CURELEA, Physical therapist

i.php?p=24. Tratamentul proctitei genera

Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Patients who use the clinic's hyperbaric therapy services benefit from:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
  • A safe medical procedure, without irradiation, without pain, without other side effects. 
  • The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
  • Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services)
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Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

What is proctitis?

Proctitis is the inflammation of the rectal mucosa causing pain, discharge, and other unusual symptoms. Pain can occur during bowel movements, it can be acute or chronic. Symptoms may vary, but the most common is tenesmus (the feeling of needing to go to the toilet), a sensation that persists even after using the toilet. 

Radiation-induced proctitis is a potential complication of pelvic radiation therapy. Standard treatments and treatment results are unpredictable. This study evaluates hyperbaric oxygen therapy (HBOT) treatment for cases of proctitis by radiation refractory to standard or laser medical therapy.

Between 2000 and 2004, 10 patients with radiation proctitis were treated with HBOT (three men and seven women; mean age 65 years). The average follow-up period was 25 months. Symptoms were marked retrospectively before and after HBOT, based on the LENT-SOMA scale.

Before treatment, three patients had grade 3 toxicity (i.e, required blood transfusions) and seven had grade 2 toxicity with dominant symptoms of rectal pain and/or diarrhea. HBOT was well tolerated and 9 out of 10 patients completed a complete HBOT treatment program. Rectal bleeding stopped completely in four of the nine symptomatic patients and improved in three other cases. Completely remitted rectal pain was reported in three of five symptomatic patients. The pain completely resolved in one in five patients and improved in another three. Of the 10 patients treated, only two did not respond to HBOT.

Materials and methods

Between August 2000 and early 2004, 10 patients with CRP who did not respond to oral or conventional treatments were tested. Clinical data were extracted from medical records and by calling patients for up-to-date information. None of the patients had conditions associated with diabetes, inflammatory bowel disease, high blood pressure, or peripheral vascular disease. All patients received treatment with radical radiation. Two patients underwent surgery before radiation (abdominoperineal resection for rectal cancer and total abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine cancer). Four cervical cancer patients received concomitant weekly infusions of cisplatin and EBRT therapy, followed by intracavitary brachytherapy. The patient with rectal cancer received EBRT, 5-FU, and folinic acid simultaneously.

All patients were treated with various medications before participating in the study. Failed treatments include:
  • Loperamide, Lomotil (diphenoxylate and atropine), psyllium fiber, steroid enemas, mesalazine / 5-ASA suppositories;
  • a variety of analgesics and YAG laser treatments. These were used for an average duration of 12 months (range 3-60 months);
  • two patients further failed in their laser coagulation attempt. All patients had endoscopic evaluations and histological confirmation of proctitis before HBOT. Routine pre-screening of HBOT included a chest x-ray, spirometry, eye exam, and audio;
Patients breathed 100% oxygen in the hyperbaric chamber at pressures between 2 and 2.5 (average: 2.4) absolute atmospheres for 90 minutes, 5 days a week for 40 treatments. The average time between the onset of proctitis and the onset of HBOT was 20 months. There have been symptoms before and after HBOT graded retroactively based on a LENT-SOMA scale for rectal injury.

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Results

Four of the ten patients developed proctitis within 6 months of completing radiation therapy; four other patients developed symptoms between 7 and 24 months after treatment and the other two patients developed symptoms 2 years after treatment. Nine of the ten patients had rectal bleeding and one had severe diarrhea. A secondary symptom associated with symptoms was diarrhea (four patients), rectal discomfort or pain (five patients), or bladder symptoms (three patients).

Three patients required multiple blood transfusions. The use of the LENT-SOMA scale resulted in seven patients with grade 2 proctitis and three patients with grade 3 proctitis.
HBOT was well tolerated by all patients. Nine patients completed the planned hyperbaric oxygen treatment. One patient had received reduced treatment. Five patients developed HBOT-related side effects: minor otic barotrauma occurred in four patients and there was fibrosis-induced pulmonary exacerbation in one patient. After completion of HBOT, these affected patients were treated with specific supportive methods. 

Patients were monitored regularly after the completion of HBOT. The mean follow-up period after completion of HBOT was 25 months. The outcome of treatment was evaluated clinically and is described in the study. Of the nine patients who completed an entire HBOT treatment, four had eliminated rectal bleeding, and three had reduced symptoms. 

Bleeding worsened in a patient who required continuous iron supplementation and regular blood transfusions. Of the five patients with rectal pain, three had a complete response, and one had a partial response. Of the five patients with diarrhea, one was cured while three achieved a partial resolution of symptoms.

Discussion

HBOT has been recommended as a safe and effective treatment for CRP. The immediate response to hyperoxygenation of HBOT tissue is the stimulation of angiogenesis and the reduction tissue edema. These changes lead to normalized tissue metabolism and tissue regeneration.

Medical therapy for radiation-induced proctitis is not always effective. Unsuccessful and uncontrolled bleeding often leads to iron deficiencies, possible transfusion-dependent anemia, and a profound negative impact on the quality of life. Moreover, surgical treatment is not the first choice due to potential postoperative complications, and due to the uncertainty of a successful outcome. HBOT can also be associated with side effects related to high environmental pressures and hyperoxia. 

These manifestations include middle ear and sinus barotrauma, pulmonary and CNS toxicity, chest tightness, angina, claustrophobia, visual problems such as myopia, usually reversible, and euphoria. In the present study, Minor otic barotrauma occurred in only four patients, and in one patient there was a respiratory compromise with all side effects and complete post-treatment resolution. The results of HBOT treatment therefore confirm that these methods are certainly more effective in radiation-induced proctitis than conservative treatments.

Pacientii au fost urmariti in mod regulat dupa terminarea HBOT. Perioada medie de urmarire de la finalizarea HBOT a fost de 25 de luni. Rezultatul tratamentului a fost evaluat clinic si este descris in studiu. Din cei noua pacienti care au terminat un intreg tratament HBOT, patru au eliminat complet sangerarea rectala si trei au avut simptome reduse. 

Sangerarea s-a agravat la un pacient care a necesitat suplimentarea continua cu fier si transfuzii periodice de sange. Dintre cei cinci pacienti cu durere rectala, trei au avut un raspuns complet si unul a avut un raspuns partial. Din cei cinci pacienti cu diaree, unul a fost vindecat complet in timp ce trei au obtinut o rezolutie partiala a simptomelor

Conclusions

Significant improvement in rectal bleeding, diarrhea, and rectal pain is possible using HBOT. HBOT should be offered to patients who fail to recover with conventional treatments for radiation-induced proctitis.

Pelvic radiotherapy can cause proctitis. This is a distinct pathological process limited to the lower 25 cm of the large intestine caused by damage to the rectal mucosa. Proctitis may develop during or shortly after radiation therapy. It comes in the form of diarrhea and tenesmus and is usually painful. Chronic radiation-induced proctitis (CRP) occurs 3 months after radiation therapy and is characterized by painless elimination of blood through the rectum (clots), rectal mucosal secretion, frequent bowel movements, and rectal pain eventually. Intestinal obstruction, fistulas, intestinal perforation, and severe rectal bleeding requiring blood transfusions may occur less frequently.

i.php?p=18. Terapia cu oxigen hiperabric

The acute action of radiation causes the death of critically active intestinal cryptic cells, while chronic damage causes progressive endarteritis leading to hypovascular, hypocellular, and hypoxic tissue. CRP is associated with prominent structural changes including mucosal atrophy, intestinal wall fibrosis, and vascular sclerosis. CRP can develop either as a result of an unhealed acute rectal lesion or after a latent period of at least 90 days. Denham and colleagues reported that patients who had acute proctitis were more likely to develop RTOG / EORTC later than patients who did not have the condition.

About 85% of cases are present in the first two years after RT. Although the true incidence is not known, estimates from retrospective data suggest that between 2 and 20% of patients receiving radical pelvic irradiation may be at risk of developing CRP. This risk will be influenced by both treatment (dose per fraction, total and technical dose) and patient-specific factors (diabetes, inflammatory bowel disease, hypertension, or peripheral vascular disease). Local hemostatic treatments include topical formalin, yttrium-aluminum-garnet (YAG) laser surgery includes the use of a dysfunctional colostomy for severe cases. Hyperbaric oxygen therapy (HBOT) has previously been described as the most non-invasive treatment option for radiation-induced proctitis.

PCR treatments are not universally successful. Current modalities include pharmacological agents such as oral and rectal steroids, amino-salicylates, sucralfate, short-chain fatty acid enemas, oral metronidazole, vitamins E and C.

The European Committee for Hyperbaric Medicine and EORTC have recommended using HBOT in the management of radiation-induced proctitis and enteritis. This study describes the researchers' experience using HBOT for patients with CRP who do not respond to topical or conventional treatment.

IN CASE YOU HAVEN'T ALREADY HEARD ABOUT US

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

  • Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
  • Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

Find the latest news by following the Facebook and YouTube accounts of the Centrokinetic clinic.  

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