Intestinal Radiation Injury Medication

  • Author: Rajeev Vasudeva, MD, FACG; Chief Editor: Julian Katz, MD   more...
 
Updated: Mar 22, 2011
 

Medication Summary

The treatment of acute injury varies depending on the symptoms, and treatment of chronic injury varies depending on the location of the injury.

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Antiemetics

Class Summary

Used to treat nausea and vomiting related to acute radiation enteritis.

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Ondansetron (Zofran)

 

Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin), and complete body radiotherapy. Also beneficial in reducing the frequency of diarrhea by delaying intestinal transit.

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Antidiarrheals

Class Summary

Used to treat diarrhea associated with acute radiation enterocolitis.

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Loperamide (Imodium)

 

Acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. Prolongs movement of electrolytes and fluid through bowel and increases viscosity and loss of fluids and electrolytes.

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Diphenoxylate and atropine (Lomotil, Lonox)

 

Drug combination that consists of diphenoxylate, which is a constipating meperidine congener and a subtherapeutic dose of atropine to discourage misuse. Inhibits excessive GI propulsion and motility.

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Cholestyramine (Questran)

 

Forms a nonabsorbable complex with bile acids in the intestine, which, in turn, inhibits enterohepatic reuptake of intestinal bile salts. Decreases diarrhea by preventing bile salt malabsorption.

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Sucralfate (Carafate)

 

An aluminum-hydroxide complex of sulfated sucrose, which forms a protective barrier at the site of ulceration due to radiation. Binds bile acids and helps to treat diarrhea from secondary bile acid malabsorption. Effective when administered PO as a prophylactic agent in preventing acute and chronic radiation injury. Studies using enemas for treatment of radiation proctitis have shown promising short-term results. No dosing standards exist, and doses used in studies vary from 1 g PO q4-6h during treatment and for another 3-4 wk thereafter.

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Topical corticosteroids

Class Summary

Used to treat symptoms related to radiation proctitis.

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Hydrocortisone (Cortenema)

 

Retention enema. An adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity. Used for its anti-inflammatory properties and effective in radiation proctitis.

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Topical formalin therapies

Class Summary

Used for intractable bleeding from radiation proctitis.

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Formaldehyde topical (Formalin 4%)

 

Direct mucosal contact allows rectal bleeding to cease.

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Contributor Information and Disclosures
Author

Rajeev Vasudeva, MD, FACG  Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association

Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Specialty Editor Board

Anil Minocha, MD, FACP, FACG  Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Intestinal radiation injury. Characteristic mucosal changes observed in radiation proctitis with multiple telangiectasias.
Intestinal radiation injury. Friability and oozing of blood from atrophic-appearing mucosa due to radiation.
Intestinal radiation injury. Appearance of mucosa after therapy with bipolar circumactive probe (BICAP) probe.
This slide illustrates disorderly crypts, fibrosis of lamina propria, and vascular dilatation, all of which are characteristic of colonic injury due to radiation. (This slide was provided courtesy of Ronald Burns, MD, Palmetto Richland Memorial Hospital, Columbia, SC.)
A deep rectal ulcer from prostate cancer radiation years ago. Patient presented with significant rectal bleeding.
After 6 months of treatment with daily Canasa (5-ASA) suppositories
Retroflexed view of the same radiation induced ulcer after 6 months of treatment
 
 
 
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