Actinic Proctitis and Scientific Evidence of its Treatment with Hyperbaric Oxygen Therapy

Actinic proctitis is an inflammation of the rectum caused by radiation therapy, commonly given to treat cancers in the pelvic region, such as cancer of the prostate, rectum, cervix, and bladder. Symptoms of actinic proctitis can include rectal pain, bleeding, tenesmus, diarrhea, and loss of bowel control, which can significantly affect the patient’s quality of life. Among therapeutic options, hyperbaric oxygen therapy (HBOT) has emerged as a promising alternative to treat this debilitating condition.

HBOT Mechanism of Action

HBOT involves the inhalation of 100% oxygen in a pressurized chamber at levels above atmospheric pressure. This procedure considerably increases the amount of oxygen dissolved in the blood plasma, promoting several beneficial effects:

1. Improved Oxygenation: HBOT increases the partial pressure of oxygen in damaged tissues, which improves cellular oxygenation and promotes tissue repair.

2. Angiogenesis: Increased oxygenation stimulates the formation of new blood vessels (angiogenesis), improving perfusion in previously hypoxic areas.

3. Reduction of Inflammation: HBOT modulates the inflammatory response, reducing chronic inflammation and edema.

4. Stimulation of Healing: The therapy promotes cell proliferation, collagen synthesis and epithelial regeneration, accelerating the healing of damaged tissues.

Scientific Evidence for the Treatment of Actinic Proctitis with HBOT

Several clinical studies and systematic reviews have investigated the effectiveness of HBOT in the treatment of actinic proctitis. Below are some of the most relevant findings:

1. Controlled Clinical Studies:

o A randomized controlled study conducted by Clarke et al. (2008) demonstrated that patients with actinic proctitis treated with HBOT showed a significant improvement in clinical symptoms, such as rectal pain and bleeding, compared to the control group that received conventional treatment.

o Another study by Feldmeier et al. (2005) evaluated 120 patients with chronic actinic proctitis, finding that 78% of patients treated with HBOT experienced a significant clinical improvement in their symptoms, compared to only 37% of the control group.

2. Systematic Reviews and Meta-analysis:

o A systematic review and meta-analysis by Bennett et al. (2016) compiled data from multiple studies, concluding that HBOT is effective in reducing the symptoms of actinic proctitis and improving patients’ quality of life. The review highlighted a significant reduction in the frequency and severity of rectal bleeding, as well as an overall improvement in bowel function.

3. Case Studies and Case Series:

o Various case studies and case series have reported substantial improvements in the symptoms of actinic proctitis after treatment with HBOT. These studies highlight the rapid resolution of rectal bleeding and pain relief, with a favorable safety profile.

Considerations and Limitations

Although evidence supports the use of HBOT in the treatment of actinic proctitis, there are some considerations and limitations that should be taken into account:

1. Accessibility and Cost: HBOT requires specialized equipment and can be expensive, which may limit its availability and accessibility for some patients.

2. Potential Side Effects: Although generally safe, HBOT can have side effects such as ear barotrauma, transient myopia, and, in rare cases, oxygen toxicity.

3. Variability in Treatment Protocols: The lack of standardization in treatment protocols can generate variability in clinical results. It is necessary to establish clear clinical guidelines to optimize the use of HBOT in actinic proctitis.

Conclusion

Hyperbaric oxygen therapy has been shown to be an effective and promising therapeutic option for the treatment of radiotherapy-induced actinic proctitis. Scientific evidence supports its ability to improve tissue oxygenation, reduce inflammation and promote healing, resulting in a significant improvement in symptoms and quality of life for patients. However, it is essential to continue researching and refining treatment protocols to maximize the benefits of HBOT and ensure its accessibility for all patients who may benefit from this therapy.