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Suzuki K, Ikenoyama Y, Hirasawa T, Yoshimizu S, Horiuchi Y, Ishiyama A, Yoshio T, Taguchi S, Yoshioka Y, Fujisaki J. Clinical course and treatment of radiation-induced hemorrhagic gastritis: a case series study. Clin J Gastroenterol 2022; 16:152-158. [PMID: 36586090 DOI: 10.1007/s12328-022-01750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Abstract
Radiation-induced hemorrhagic gastritis is a relatively uncommon complication of irradiation that can be severe. However, appropriate treatment guidelines have not yet been established because of the small number of known cases. At our hospital, we encountered nine cases of radiation-induced hemorrhagic gastritis between July 2005 and July 2018. All patients initially underwent argon plasma coagulation (APC) for hemostasis. The treatment was highly effective, and hemostasis was successfully achieved in eight of the cases. Hemostasis could not be achieved in one case treated with APC; therefore, surgical resection was required. This patient had risk factors, such as liver cirrhosis and a history of abdominal surgery. Our case series suggests that APC is an effective hemostatic method that should be considered as the initial treatment option for radiation-induced hemorrhagic gastritis; however, surgical resection may be considered when the patient is at high risk for rebleeding.
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Affiliation(s)
- Keita Suzuki
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yohei Ikenoyama
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
| | - Senzo Taguchi
- Department of Radiation Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto, Tokyo, 135-8550, Japan
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Madala S, Polavarapu A, Gurala D, Gumaste V. Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy. Case Rep Gastroenterol 2021; 15:513-518. [PMID: 34616249 PMCID: PMC8454251 DOI: 10.1159/000516569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022] Open
Abstract
We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. There is an increased risk of bleeding with both entities present together. Our aim is to focus on treatment and possible prevention of gastrointestinal bleeding in patients with preexisting PHG undergoing radiation therapy for newly diagnosed cancer. Several therapies like prednisolone, argon plasma coagulation, laser coagulation have been proposed. There are no set guidelines for treatment. In these patients, if radiation therapy is indicated either for hepatic or gastrointestinal malignancy, it is suggested to premedicate with proton pump inhibitors or sucralfate. We describe a case of 73-year-old female who presented with upper gastrointestinal bleeding. She had liver cirrhosis secondary to nonalcoholic fatty liver disease and diagnosed with pancreatic cancer, for which she received chemoradiation. She was found to have both radiation gastritis and PHG with diffuse erythematous, edematous, congested mucosa with diffuse oozing blood in the antrum making it very challenging to treat.
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Affiliation(s)
- Samragnyi Madala
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Abhishek Polavarapu
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
| | - Dhineshreddy Gurala
- Department of Internal Medicine, Staten Island University Hospital, New York, New York, USA
| | - Vivek Gumaste
- Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA
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Liang M, Liwen Z, Juan D, Yun Z, Yanbo D, Jianping C. A case report of endoscopic therapy for radiation-induced hemorrhagic gastritis in patient with recurrent hepatocellular carcinoma. Medicine (Baltimore) 2018; 97:e13535. [PMID: 30572453 PMCID: PMC6320029 DOI: 10.1097/md.0000000000013535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Radiation-induced hemorrhagic gastritis is an infrequent cause of upper gastrointestinal bleeding and difficult to manage. The current standard treatment has not been well established. PATIENT CONCERNS We described a 32-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for hepatocellular carcinoma recurrence. DIAGNOSES The endoscopic examination showed a diffuse area of bleeding in the gastric antrum. INTERVENTIONS After failure of conventional hemostasis treatment, we successfully stopped the hemorrhage with repeated endoscopic argon plasma coagulation (APC) combined with low-dose polyglycerol sclerotherapy. OUTCOMES The patient was followed up for 6 months to date without recurrence. LESSONS Based on this case, we think that endoscopic APC combined with low-dose polidocanol sclerotherapy can be tried as a treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.
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Affiliation(s)
- Ma Liang
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Zhang Liwen
- Department of Pediatrics, the Second People's Hospital of Changzhou, Affiliate Hospital of NanJing Medical University, Changzhou, Jiangsu, China
| | - Dai Juan
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Zhuang Yun
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Ding Yanbo
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Chen Jianping
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
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Najafi M, Motevaseli E, Shirazi A, Geraily G, Rezaeyan A, Norouzi F, Rezapoor S, Abdollahi H. Mechanisms of inflammatory responses to radiation and normal tissues toxicity: clinical implications. Int J Radiat Biol 2018; 94:335-356. [PMID: 29504497 DOI: 10.1080/09553002.2018.1440092] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 01/23/2018] [Accepted: 01/31/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Cancer treatment is one of the most challenging diseases in the present era. Among a few modalities for cancer therapy, radiotherapy plays a pivotal role in more than half of all treatments alone or combined with other cancer treatment modalities. Management of normal tissue toxicity induced by radiation is one of the most important limiting factors for an appropriate radiation treatment course. The evaluation of mechanisms of normal tissue toxicity has shown that immune responses especially inflammatory responses play a key role in both early and late side effects of exposure to ionizing radiation (IR). DNA damage and cell death, as well as damage to some organelles such as mitochondria initiate several signaling pathways that result in the response of immune cells. Massive cell damage which is a common phenomenon following exposure to a high dose of IR cause secretion of a lot of inflammatory mediators including cytokines and chemokines. These mediators initiate different changes in normal tissues that may continue for a long time after irradiation. In this study, we reviewed the mechanisms of inflammatory responses to IR that are involved in normal tissue toxicity and considered as the most important limiting factors in radiotherapy. Also, we introduced some agents that have been proposed for management of these responses. CONCLUSIONS The early inflammation during the radiation treatment is often a limiting factor in radiotherapy. In addition to the limiting factors, chronic inflammatory responses may increase the risk of second primary cancers through continuous free radical production, attenuation of tumor suppressor genes, and activation of oncogenes. Moreover, these effects may influence non-irradiated tissues through a mechanism named bystander effect.
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Affiliation(s)
- Masoud Najafi
- a Radiology and Nuclear Medicine Department, School of Paramedical Sciences , Kermanshah University of Medical Science , Kermanshah , Iran
| | - Elahe Motevaseli
- b Department of Molecular Medicine, School of Advanced Technologies in Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Alireza Shirazi
- c Department of Medical Physics and Biomedical Engineering, Faculty of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Ghazale Geraily
- c Department of Medical Physics and Biomedical Engineering, Faculty of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Abolhasan Rezaeyan
- d Department of Medical Physics, School of Medicine , Iran University of Medical Sciences , Tehran , Iran
| | - Farzad Norouzi
- e Science and Research Branch , Azad University , Tehran , Iran
| | - Saeed Rezapoor
- f Department of Radiology, Faculty of Paramedical Sciences , Tehran University of Medical Sciences , Tehran , Iran
| | - Hamid Abdollahi
- d Department of Medical Physics, School of Medicine , Iran University of Medical Sciences , Tehran , Iran
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First Case of Radiation-Induced Diffuse Hemorrhagic Gastritis Successfully Treated with Intravenous Bevazicumab. Am J Gastroenterol 2017; 112:1349-1350. [PMID: 28766568 DOI: 10.1038/ajg.2017.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Preoperative chemoradiotherapy does not compromise the feasibility of adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma. Surg Today 2016; 47:218-226. [PMID: 27586014 DOI: 10.1007/s00595-016-1405-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/10/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Preoperative chemoradiotherapy (CRT) is a novel, emerging treatment strategy for pancreatic ductal adenocarcinoma (PDAC), but it remains unclear whether post-surgery adjuvant chemotherapy is feasible following preoperative CRT. This retrospective study evaluates the feasibility of adjuvant therapy after preoperative CRT. METHODS The subjects of this study were 99 consecutive patients who underwent pancreatectomy for PDAC between January, 2007 and February, 2013 in our hospital. Sixty patients received preoperative CRT: as gemcitabine (GEM) and 40 Gy radiation in 28 (G-CRT group), and as GEM, S-1, and 50.4 Gy radiation in 32 (GS-CRT group). We also evaluated 39 patients who underwent surgery alone (SA group). We investigated adjuvant chemotherapy induction and completion rates and the frequency of adverse events rated ≥grade 3, based on Common Terminology Criteria for Adverse Events (version 4.0) in all three groups. RESULTS In the G-CRT, GS-CRT, and SA groups, the induction rates were 78 % (22/28), 78 % (25/32), and 72 % (28/39), respectively; completion rates were 86 % (19/22), 88 % (22/25), and 82 % (23/28), respectively; and adverse event frequencies were 36 % (8/22), 28 % (7/25), and 43 % (12/28), respectively. No significant difference was found among the three groups. CONCLUSION Preoperative CRT was demonstrated to be safe and did not compromise the feasibility of adjuvant chemotherapy.
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Guo XP, Wei HL, Zhang XL, Zhou P. Research status of radiation induced gastroduodenal injury. Shijie Huaren Xiaohua Zazhi 2015; 23:5472-5478. [DOI: 10.11569/wcjd.v23.i34.5472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
With the development of modern radiotherapy techniques, such as three dimensional conformal radiotherapy, Gamma-knife treatment, and tomotherapy, patients who have abdominal tumors like liver cancer, pancreatic cancer, and colon cancer can live longer. The wide use of radiation therapy increases the incidence of gastroduodenal radioactive injury. This article reviews the pathogenesis and pathological characteristic of radiation induced gastroduodenal injury, factors influencing the injury, and the diagnosis and treatment of radiation induced gastroduodenal injury. Currently, there have been few studies on the mechanism of radiation induced gastroduodenal injury. The optimal timing of endoscopic examination after radiotherapy is still inconclusive. V25 for the stomach, V35 for the duodenum and aV55 Gy for the duodenum are predictive factors for gastroduodenal toxicity (>grade 2, CTCAE3.0). There has been no treatment standard for curing radiation induced gastroduodenitis. Traditional Chinese medicine has unique advantages in the prevention and control of radiation induced gastroduodenal injury.
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Gu JF, Ding W, Hu J, Li ZY, Li MF. Treatment of malignant gastric outlet obstruction by endoscopic metal stent implantation with argon plasma coagulation: Analysis of 27 cases. Shijie Huaren Xiaohua Zazhi 2014; 22:4482-4486. [DOI: 10.11569/wcjd.v22.i29.4482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy and safety of endoscopic self-expandable metal stent implantation with argon plasma coagulation in the treatment of malignant gastric outlet obstruction.
METHODS: Clinical data for 54 patients with malignant gastric outlet obstruction diagnosed from February 2010 to November 2013 were retrospectively analyzed. The patients were divided two groups: a control group (n = 27) and a treatment group (n = 27). The control group was treated by implantation of simple metal stents, while the treatment group was treated by implantation of self-expandable metal stents with argon plasma coagulation.
RESULTS: Self-expandable metal stent placement was successful in all patients. Fifty-four patients were able to take liquid food and soft food within 24 h after the procedure. Pain developed in 4 cases in the control group, and 2 cases in the treatment group. Three cases in the control group developed restenosis 2 mo after surgery, while only one case in the treatment group had restenosis 4.3 mo after surgery. No bleeding or perforation occurred. Two cases in the control group died after 6 mo. The treatment group was superior to the control group in terms of symptoms, food intake, survival and quality of life.
CONCLUSION: Placement of a self-expandable metal stent combined with argon plasma coagulation in patients with malignant gastric outlet obstruction is safe and effective for resolving obstruction symptoms.
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Yun HG, Kim HY, Kim DY, Lim YJ. Successful treatment of intractable bleeding caused by radiation-induced hemorrhagic gastritis using oral prednisolone: a case report. Cancer Res Treat 2014; 47:334-8. [PMID: 25327495 PMCID: PMC4398121 DOI: 10.4143/crt.2013.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/31/2013] [Indexed: 12/25/2022] Open
Abstract
Radiation-induced hemorrhagic gastritis is an intractable and dangerous condition. We describe a 59-year-old female patient with radiation-induced hemorrhagic gastritis. The patient underwent postoperative radiation therapy with a dose of 54 Gy in 30 fractions after a radical operation for a Klatskin tumor. Radiation volume included the gastric antrum. Approximately three months after radiation therapy, she was admitted for melena and anemia. Esophagogastroduodenoscopy showed an area of bleeding in the gastric antrum that was so diffuse that effective laser coagulation was not feasible. After failure of various treatments and transfusion of 7,040 mL of packed red blood cells, we successfully stopped the hemorrhage using oral prednisolone treatment. Based on this case, we think that oral prednisolone treatment can be tried as a first treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.
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Affiliation(s)
- Hyong Geun Yun
- Department of Radiation Oncology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hong Yong Kim
- Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Kwak HW, Lee WJ, Woo SM, Kim BH, Park JW, Kim CM, Kim TH, Han SS, Kim SH, Park SJ, Kook MC. Efficacy of argon plasma coagulation in the treatment of radiation-induced hemorrhagic gastroduodenal vascular ectasia. Scand J Gastroenterol 2014; 49:238-45. [PMID: 24286663 DOI: 10.3109/00365521.2013.865783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Radiation-induced hemorrhagic gastroduodenal vascular ectasia (GDVE) is rare but difficult to manage. Argon plasma coagulation (APC) has not yet been evaluated in the treatment of radiation-induced hemorrhagic GDVE. The efficacy of APC in patients with radiation-induced hemorrhagic GDVE has been investigated in this article. MATERIAL AND METHODS Eighteen patients with upper gastrointestinal (GI) bleeding caused by radiation-induced GDVE, including 13 with hepatocellular carcinoma, 3 with pancreatic cancer, and 2 with cholangiocarcinoma, were treated with APC. The efficacy of APC was retrospectively evaluated, based on cessation of macroscopic GI bleeding, resolution or stabilization of anemia and transfusion dependence, endoscopic ablation of almost all vascular lesions, complications, and recurrence. RESULTS Mean patient age was 59 years (range 42-80 years). The median time from radiation to GDVE diagnosis was 4.6 months (range 3.3-21.5 months). The median number of APC sessions per patient was 2.4 (range 1-4). All 18 patients showed an endoscopic response to APC treatment, with sustained increases in mean hemoglobin level, from 6.6 g/dL (range 2.9-9.5 g/dL) to 9.7 g/dL (range 7.1-12.7 g/dL) (p < 0.001), and decreased dependence on transfusion, from 9.1 (range 0-30) to 4.1 (range 0-15) units of packed red blood cells per patient (p = 0.038) after last endoscopic eradication by APC treatment. There were no major procedure-related adverse events or deaths. At a median follow up of 4.7 months (range 0.6-24.5 months), none of the patients experienced recurrence of GDVE. CONCLUSIONS APC showed short-term effectiveness and safety in the treatment of radiation-induced hemorrhagic GDVE.
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Affiliation(s)
- Hee-Won Kwak
- Center for Liver Cancer, National Cancer Center , Goyang , Korea
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Zhang L, Xie XY, Wang Y, Wang YH, Chen Y, Ren ZG. Treatment of radiation-induced hemorrhagic gastritis with prednisolone: A case report. World J Gastroenterol 2012; 18:7402-7404. [PMID: 23326152 PMCID: PMC3544049 DOI: 10.3748/wjg.v18.i48.7402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Radiation-induced gastritis is an infrequent cause of gastrointestinal bleeding. It is a serious complication arising from radiation therapy, and the standard treatment method has not been established. The initial injury is characteristically acute inflammation of gastric mucosa. We presented a 46-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for metastatic retroperitoneal lymph node of hepatocellular carcinoma. The endoscopic examination showed diffuse edematous hyperemicmucosa with telangiectasias in the whole muscosa of the stomach and duodenal bulb. Multiple hemorrhagic patches with active oozing were found over the antrum. Anti-secretary therapy was initiated for hemostasis, but melena still occurred off and on. Finally, he was successfully treated by prednisolone therapy. We therefore strongly argue in favor of perdnisolone therapy to effectively treat patients with radiation-induced hemorrhagic gastritis.
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Hashizume H, Sato K, Horiguchi N, Yamazaki Y, Kakizaki S, Sakurai H, Mori M. A case of hemorrhagic gastroduodenitis after proton beam radiation for pancreatic cancer with multiple hemorrhagic risk factors: successful treatment with argon plasma coagulation. Clin J Gastroenterol 2012; 5:336-340. [PMID: 26181072 DOI: 10.1007/s12328-012-0329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/08/2012] [Indexed: 10/28/2022]
Abstract
Radiation-induced gastroduodenitis is a well-known but rare disorder causing uncontrollable hemorrhage and has not been reported as a complication of proton beam therapy in radiation treatment. Argon plasma coagulation (APC) has been shown to be effective and safe in the management of radiation-induced hemorrhagic gastroduodenitis. We describe a case of hemorrhagic gastroduodenitis after proton beam radiation therapy for pancreatic cancer with multiple hemorrhagic risk factors, which was treated successfully with APC. A 62-year-old man was diagnosed as having early pancreatic cancer that was incidentally detected on computed tomography when screening for hepatocellular carcinoma. He opted to receive radical proton beam radiation for pancreatic cancer but not surgery because he had multiple risk factors such as liver cirrhosis due to hepatitis C virus and chronic renal failure that required hemodialysis. Three months later, however, he developed hemorrhagic gastroduodenitis induced by proton beam radiation although the cancer had been eradicated. Initially, he required frequent blood transfusions, but his disease condition improved dramatically after several endoscopic treatments using APC. The patient has been free of relapse after pancreatic cancer for >2 years.
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Affiliation(s)
- Hiroaki Hashizume
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Ken Sato
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Norio Horiguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Yuichi Yamazaki
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Satoru Kakizaki
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Ibaraki, Japan
| | - Masatomo Mori
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Kawata K, Kobayashi Y, Souda K, Kawamura K, Takahashi Y, Noritake H, Watanabe S, Suehiro T, Kamiya M, Yamashita S, Ushio T, Nakamura H. Hemorrhagic radiation gastritis successfully treated with repeated intra-arterial steroid infusions. Clin J Gastroenterol 2010; 4:34-8. [PMID: 26190619 DOI: 10.1007/s12328-010-0191-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 11/09/2010] [Indexed: 02/06/2023]
Abstract
Intra-arterial steroid infusion therapy has previously been shown to be effective for inflammatory bowel disease; however, few cases in which it has been used for the treatment of hemorrhagic radiation gastritis have been reported. We report the case of a 70-year-old Japanese man with hemorrhagic radiation gastritis induced by radiation therapy for para-aortic lymph node metastases of hepatocellular carcinoma. Two months after completing radiation therapy, acute persistent bleeding occurred in the gastric irradiation area. Although argon plasma coagulation was performed five times over a month, the bleeding continued and the patient showed persistent anemia that required 50 units of blood transfusion. Finally, the patient was given intra-arterial steroid infusions through the right gastric artery and the right gastroepiploic artery. After three intra-arterial steroid infusions, the melena stopped, and the anemia no longer progressed. Hemorrhagic radiation gastritis was successfully treated with repeated intra-arterial steroid infusions through the regional vessels to the gastric mucosa. Repeated intra-arterial steroid infusions could be a clinically useful option for the treatment of intractable bleeding from radiation gastritis.
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Affiliation(s)
- Kazuhito Kawata
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yoshimasa Kobayashi
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kenichi Souda
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kinya Kawamura
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yurimi Takahashi
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hidenao Noritake
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shinya Watanabe
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomoyuki Suehiro
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mika Kamiya
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shuhei Yamashita
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takasuke Ushio
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hirotoshi Nakamura
- Hepatology Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan
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