The Experts below are selected from a list of 3066 Experts worldwide ranked by ideXlab platform
David T Rubin - One of the best experts on this subject based on the ideXlab platform.
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budesonide foam has a favorable safety profile for inducing remission in mild to moderate ulcerative Proctitis or proctosigmoiditis
Digestive Diseases and Sciences, 2015Co-Authors: David T Rubin, William J Sandborn, Brian P Bosworth, Salam Zakko, Glenn L Gordon, Pamela L Golden, Robert L Rolleri, Andrew C Barrett, Mark Sale, Enoch BorteyAbstract:Background Budesonide foam, a rectally administered, second-generation corticosteroid with extensive hepatic first-pass metabolism, is efficacious for the treatment of mild-to-moderate ulcerative Proctitis and ulcerative proctosigmoiditis.
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infectious Proctitis when to suspect it is not inflammatory bowel disease
Digestive Diseases and Sciences, 2012Co-Authors: Frank Hoentjen, David T RubinAbstract:Background Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases. However, the incidence of infectious Proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections. The most frequently reported pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex.
Joe J. Tjandra - One of the best experts on this subject based on the ideXlab platform.
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argon plasma coagulation in chronic radiation Proctitis
Endoscopy, 2007Co-Authors: A Postgate, Joe J. Tjandra, Brian P Saunders, John J VargoAbstract:Chronic radiation Proctitis is a relatively common late complication of pelvic irradiation. The main symptoms are diarrhea, urgency, tenesmus, and rectal bleeding. While mild cases may settle spontaneously over some months, severe hemorrhagic radiation Proctitis may require repeated blood transfusions and is difficult to treat with medical therapy. Argon plasma coagulation (APC) is a noncontact thermal coagulation technique which can be applied endoscopically. A probe passed through the scope delivers a field of argon gas to the mucosal surface where it is ionized by a high voltage filament, resulting in superficial mucosal heating and coagulation of friable blood vessels. The technique reduces rectal bleeding in 80%-90% of cases, and may improve the other troublesome symptoms of diarrhea and urgency. APC is probably less effective in very severe cases of hemorrhagic radiation Proctitis; in these cases topical formalin or a combination of APC and topical formalin can be useful. Overall, APC has proved to be a safe and well tolerated technique.
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Argon plasma coagulation is an effective treatment for refractory hemorrhagic radiation Proctitis
Diseases of the Colon & Rectum, 2001Co-Authors: Joe J. Tjandra, Shomik SenguptaAbstract:INTRODUCTION: Chronic radiation Proctitis complicating pelvic radiotherapy can be debilitating. It commonly presents with rectal bleeding, which can be difficult to control. Medical management of hemorrhagic radiation Proctitis is not very successful, although surgery carries high risks. Thus, endoscopic treatments are preferred. The aim of this study is to assess the efficacy of argon plasma coagulation applied endoscopically to treat hemorrhagic radiation Proctitis that has been refractory to topical formalin therapy. METHODS: Twelve patients who had ongoing bleeding from radiation Proctitis, after previously failed formalin therapy, underwent endoscopic treatment using argon plasma coagulation. The efficacy of treatment was assessed by grading the frequency and severity of bleeding (0–4, 0 being no bleeding), hemoglobin level, and transfusion requirements. RESULTS: At a median follow-up of 11 months, ten patients (83 percent) had a significant reduction in the severity and frequency of bleeding, with complete cessation in six (50 percent). The presence of coexistent radiation-induced sigmoiditis in two patients was associated with reduced but persistent bleeding, because of difficulty in targeting the bleeding sites in the sigmoid colon. The median number of treatment sessions per patient was two (range, 1–3), with the number of sessions correlated with the extent of the Proctitis. All patients had an improvement in their hemoglobin level, with the mean increasing from 11.2 to 12.3 g/dl. In the six months before starting therapy, all patients had been taking iron supplements, and four had required blood transfusions (median 3 units, range, 2–6). Iron supplements were ceased four weeks after the completion of therapy in all cases, and no further transfusions were required during the study period. None of the patients experienced any significant side effects or complications. CONCLUSIONS: Argon plasma coagulation is an effective and safe treatment for hemorrhagic radiation Proctitis that has been refractory to topical formalin therapy.
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chronic radiation Proctitis
Anz Journal of Surgery, 2001Co-Authors: Peter Tagkalidis, Joe J. TjandraAbstract:Background: Increasing use of radiation therapy in pelvic malignancy has led to an increase in the incidence of chronic radiation Proctitis. The commonest presenting complaint is rectal bleeding. Methods: A comprehensive MEDLINE search was undertaken for all articles relating to radiation Proctitis. Results: The natural history of the disease is poorly documented but improvement is likely in milder forms, with persistence of symptoms in more severe forms. The pathological manifestations of the disease are summarized with particular comparison to acute radiation Proctitis. The common clinical presentations and the principles of assessing patients with radiation-induced Proctitis will be reviewed. The present article also reviews current treatment options, with particular reference to newer endoscopic therapies and surgical principles of management. Conclusions: The initial therapy for problematic rectal bleeding related to radiation-induced Proctitis shoud be endoscopic therapy with argon plasma coagulation or topical formalin therapy. Surgery is reserved as a last resort for resistant rectal bleeding and for complicated radiation-induced strictures and fistulas.
Bernard Flourie - One of the best experts on this subject based on the ideXlab platform.
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Infliximab for refractory ulcerative Proctitis.
Alimentary pharmacology & therapeutics, 2010Co-Authors: Guillaume Bouguen, Xavier Roblin, Jérome Filippi, Xavier Hébuterne, Arnaud Bourreille, Laura Feier, Stéphane Nancey, Jean-françois Bretagne, Bernard Flourie, Marc-andré BigardAbstract:Aliment Pharmacol Ther 31, 1178–1185 Summary Background Efficacy of infliximab in treating ulcerative Proctitis remains unknown. Aim To evaluate the clinical, biological and endoscopic efficacy of infliximab therapy in refractory Proctitis. Methods The charts of 420 patients treated with infliximab for ulcerative colitis were reviewed. Thirteen patients were treated with infliximab for refractory ulcerative Proctitis in six referral centres between 2005 and 2009. Results Following infliximab therapy induction, 9/13 patients (69%) had a complete response (defined as absence of diarrhoea and blood), 2/13 (15%) had a partial response and 2/13 (15%) were primary nonresponders. The median follow-up was 17 months (range, 3–48). Among the 11 patients with clinical response after infliximab induction therapy, 9 (82%) patients maintained response at last follow-up. Disappearance of rectal disorders was observed in all nine patients who maintained clinical response at last follow-up. Following infliximab induction therapy, the mean CRP level fell from 12.8 mg/L to 4.7 mg/L. Endoscopic evaluation was performed before and after infliximab in seven patients, showing an improvement in mucosal lesions in four patients, persistent mild endoscopic activity in two patients and no improvement in one patient. One patient underwent proctocolectomy. Conclusion Infliximab therapy seems to be effective in inducing and maintaining a clinical response in refractory ulcerative Proctitis.
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Effective use of argon plasma coagulation in the treatment of severe radiation Proctitis
Diseases of the Colon & Rectum, 2001Co-Authors: Sarah Taïeb, Stéphane Nancey, Alain Rolachon, Jean-claude Cenni, Sylvette Bonvoisin, Louis Descos, Jacques Fournet, Jean-pierre Gérard, Bernard FlourieAbstract:PURPOSE: Chronic radiation Proctitis, a well described complication of pelvic radiation therapy, can result in severe bleeding that is refractory to conventional treatment. Argon plasma coagulation is an effective treatment for hemorrhagic lesions of the gastrointestinal tract. The aim of this study was to assess the efficacy and safety of argon plasma coagulation in the management of severe radiation Proctitis resistant to medical treatment. METHODS: Eleven patients (10 males) aged between 54 and 86 years (mean ± standard error of the mean, 73±3.years), with chronic radiation Proctitis after radiotherapy for prostate (n=9), uterine (n=1) or rectal (n=1) cancer were enrolled in this prospective study. Traditional therapies had failed including mainly topical steroids, 5-aminosalicylic acid and sometimes sucralfate. All patients had active bleeding from diffuse telangiectasias responsible for chronic anemia and seven of them required blood transfusions. The mean duration of the sessions was 20 minutes and one to five sessions (mean, 3.2±0.4), usually without anesthesia, were required to stop bleeding. Mean follow-up time was 19±2 (range, 7–30) months. RESULTS: Rectal bleeding disappeared in nine patients and was greatly reduced in two. All the patients were free of transfusions during the mean follow-up of 19 months. The mean hemoglobin level was 7.7±2.8 g/dl at the first session and increased significantly ( P =0.003) to 11.5±2.6 g/dl after treatment. In two patients, a rectal stenosis appeared 7 and 11 months after the first session. CONCLUSION: Argon plasma coagulation is a simple, inexpensive and effective treatment for severe refractory radiation Proctitis with telangiectasias. Follow-up supervision is in progress to evaluate long term benefits and the risk of rectal stenosis.
John M Corman - One of the best experts on this subject based on the ideXlab platform.
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hyperbaric oxygen therapy for radiation induced proctopathy in men treated for prostate cancer
The Journal of Urology, 2006Co-Authors: Marc A Dallera, Neil B Hampson, Alex R Hsi, Berit Madsen, John M CormanAbstract:Purpose: Radiation Proctitis is a common complication following external beam radiation therapy and brachytherapy for prostate cancer. While 95% percent of radiation induced Proctitis is temporary and self-limiting, up to 5% of patients experience toxicities that are refractory to conservative management. Hyperbaric oxygen has a well-defined role in treating chronic wounds, osteomyelitis, hemorrhagic cystitis and necrotizing fasciitis. We reviewed our experience with hyperbaric oxygen therapy for radiation induced Proctitis in patients undergoing radiation treatment for prostate cancer.Materials and Methods: From October 1998 to December 2003, 27 patients with radiation induced Proctitis secondary to brachytherapy (4), external beam radiation therapy (16) or combined modality (7) for prostate cancer were treated with hyperbaric oxygen therapy at Virginia Mason Medical Center in Seattle, Washington. In all patients primary medical or endoscopic management had failed. Patients received 100% oxygen in a mult...
Alessandro Repici - One of the best experts on this subject based on the ideXlab platform.
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radiofrequency ablation for the treatment of radiation Proctitis
Endoscopy, 2014Co-Authors: Xavier Dray, Gorgio Battaglia, Dov Wengrower, Pedro Gonzalez, Alessandra Carlino, M Camus, Tomer Adar, Francisco Perezroldan, P Marteau, Alessandro RepiciAbstract:Background and study aims: The main endoscopic therapy for radiation Proctitis is argon plasma coagulation (APC); however treatment is not always successful. Radiofrequency ablation (RFA) is a possible treatment for radiation Proctitis but data are scarce. The aim of this study was to report on the safety and efficacy of RFA in the treatment of radiation Proctitis. Patients and methods: This study was an open-label, retrospective, multicenter study of patients with chronic hemorrhagic radiation Proctitis who were treated with RFA. Data included a three-item symptom score, the number of packed red blood cell transfusions, the lowest hemoglobin concentration, and complications, during the 6 months prior to and after RFA. Clinical success was defined as a decrease in the symptom score. Biological success was defined as an increase in the hemoglobin rate with equal or decreased number of transfusions required. Results: A total of 17 patients underwent a median of 2 RFA sessions (range 1 – 4), without perioperative complications. Symptom scores decreased in 16 patients (clinical success 94 %), from a mean score of 3.6 (median 4) to 1.4 (median 1) ( P P P Conclusions: RFA seems to significantly decrease clinical symptoms and increase the hemoglobin concentration, thus reducing the need for transfusions.
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radiofrequency ablation for the treatment of radiation Proctitis
Endoscopy, 2014Co-Authors: Xavier Dray, Gorgio Battaglia, Dov Wengrower, Pedro Gonzalez, Alessandra Carlino, M Camus, Tomer Adar, Francisco Perezroldan, P Marteau, Alessandro RepiciAbstract:BACKGROUND AND STUDY AIMS: The main endoscopic therapy for radiation Proctitis is argon plasma coagulation (APC); however treatment is not always successful. Radiofrequency ablation (RFA) is a possible treatment for radiation Proctitis but data are scarce. The aim of this study was to report on the safety and efficacy of RFA in the treatment of radiation Proctitis. PATIENTS AND METHODS: This study was an open-label, retrospective, multicenter study of patients with chronic hemorrhagic radiation Proctitis who were treated with RFA. Data included a three-item symptom score, the number of packed red blood cell transfusions, the lowest hemoglobin concentration, and complications, during the 6 months prior to and after RFA. Clinical success was defined as a decrease in the symptom score. Biological success was defined as an increase in the hemoglobin rate with equal or decreased number of transfusions required. RESULTS: A total of 17 patients underwent a median of 2 RFA sessions (range 1 - 4), without perioperative complications. Symptom scores decreased in 16 patients (clinical success 94 %), from a mean score of 3.6 (median 4) to 1.4 (median 1) (P < 0.01). Two patients developed rectal ulceration, with no local symptoms. During the 6 months after RFA, hemoglobin concentration increased in all 17 patients (from mean 8.3 ± 2.8 g/dL [median 7.5] to 11.3 ± 2.2 g/dL [median 11.0]; P < 0.01). Among 13 patients who were transfusion dependent prior to RFA (mean 7.2 ± 7.7 transfusions [median 4]), 9 patients (69 %) were weaned off transfusions after RFA. A significant increase in the hemoglobin level was observed in this subgroup of patients (from mean 7.2 ± 1.4 g/dL [median 7.3] to 10.7 ± 1.5 g/dL [median 10.5]; P < 0.001). Biological success was 100 %. CONCLUSIONS: RFA seems to significantly decrease clinical symptoms and increase the hemoglobin concentration, thus reducing the need for transfusions.
