Journal of Inflammatory Bowel Diseases & Disorders

Objectives: In many patients, Ulcerative Colitis (UC) is poorly controlled; patients frequently fail to achieve remission or relapse on current therapies. Multiple disease mechanisms have been postulated but resulting therapies fail to deliver complete histological and clinical remission in a majority of patients. This case series reports clinical experience treating patients with active UC, not responding to conventional therapies, with a combination enema and oral therapy, to test whether it could induce remission in refractory, moderate to severe disease.

Methods: A four-component enema consisting of approved medications and generally regarded as safe ingredients, and oral dihydrolipoic acid, was administered daily for up to eight weeks. Thirty-six patients with UC experiencing a current flare not responding to other UC medications were treated. Patients were assessed at the initiation of treatment and two follow-up visits, visit 1 (average 26 days) and visit 2 (average 54 days), for symptoms and by endoscopic and histologic examination.

Results: Thirty-five (of 36) patients had moderate to severe disease at the initial pre-treatment assessment. At visit 1, 71% of patients achieved histological remission, 65% were in complete mucosal remission, 94% patients had a clinical response and 71% of patients achieved clinical remission. By visit 2, 85% of patients achieved histological remission, 85% were in complete mucosal remission, 97% of patients had a clinical response and 87% of patients achieved clinical remission. The regimen was well tolerated.

Conclusions: A combination oral/enema regimen was effective at inducing clinical, endoscopic and histological remission in moderate to severe UC patients experiencing a flare that was not controlled by their existing UC medications.

Conventionally, radiation therapy (RT) in patients with inflammatory bowel disease (IBD) patients is considered to cause serious gastrointestinal (GI) tract. adverse events; thus, these patients are unable to receive the same RT as that administered to patients without IBD. However, it is unclear whether RT in IBD patients causes serious adverse events or poorly controlled IBD. The purpose of this study was to clarify the acute and late radiological GI toxicity in IBD patients.

Objective of the study:  To evaluate the tolerability of radiation therapy in patients with inflammatory bowel disease.

 Patients and methods: Data of IBD patients who received RT to the abdominal pelvis in our hospital between 1997 and 2017 were reviewed retrospectively. We excluded cases that were not irradiated to the GI tract. Radiation toxicity was examined according to the Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE v4.0). Toxicity that occurred within 90 days from the last administration of RT was defined as acute toxicity, while toxicity occurring thereafter was defined as late toxicity.

Results: Our study included 17 patients; nine with ulcerative colitis (UC), seven with Crohn's disease (CD), and one unknown case. The median follow-up period after irradiation was 19 months. Median total dose of RT was 50 Gy (range; 3-145). Median dose per fraction was 2 Gy (range; 1.8-8). 16 patients received three-dimensional external beam radiotherapy (3D-EBRT) and 1 patient received low dose rate (low dose rate) brachytherapy. Regarding irradiation field, the whole pelvis was used in two cases, small pelvis in two cases, tumour bed or local region in nine cases, total body irradiation (TBI) in three cases, and whole brain and total spinal cord in one case. No Grade 3 or higher GI toxicities were observed in either the acute or late phases. IBD activity exacerbations were not clearly observed after RT.

Conclusion:  Our results indicated that RT of the abdomen or pelvis was tolerable in patients with IBD.