<iframe src="//www.googletagmanager.com/ns.html?id=GTM-5TSRKG" height="0" width="0" style="display: none; visibility: hidden">
Research Article
No access
Published Online: 1 November 2017

Successful Treatment of Acute Radiation Proctitis with Aloe Vera: A Preliminary Randomized Controlled Clinical Trial

Publication: The Journal of Alternative and Complementary Medicine
Volume 23, Issue Number 11

Abstract

Background: Acute radiation proctitis (ARP) is a common side-effect that affects up to 50% of patients receiving radiotherapy. The aim of this study was to evaluate the role of a topical preparation of Aloe vera in the treatment of ARP induced by radiotherapy of pelvic area.
Subjects and Interventions: In this double-blind placebo-controlled trial, 20 consecutive patients with ARP after external-beam radiation therapy (46–72 Gy) of pelvic malignancies were randomized to receive either Aloe vera 3% or placebo ointment, 1 g twice daily for 4 weeks. These patients presented with at least two of the following symptoms: rectal bleeding, abdominal/rectal pain, diarrhea, or fecal urgency. These symptoms were rated by the patients in terms of their severity (grade 0–4) for each of the symptoms mentioned earlier at baseline and then weekly for 4 weeks. A symptom index was calculated by the addition of the scores (16 most symptomatic). Radiation Therapy Oncology Group (RTOG) acute toxicity criteria and psychosocial status of the patients were also recorded weekly. The lifestyle impact of the symptoms was assessed by questionnaire grading from 0 (no effect on daily activity) to 4 (afraid to leave home).
Results: There was a significant (p < 0.05) improvement in the symptom index (before treatment vs. after treatment with Aloe vera) for diarrhea (median score: 0.67 vs. 0.11), fecal urgency (median score: 0.89 vs. 0.11), clinical presentation total (median score: 4.33 vs. 1.22), RTOG total (median score: 2.89 vs. 0.89), and lifestyle (median score: 1.1 vs. 0.33). Hemorrhage and abdominal/rectal pain did not improve significantly. The odds ratios for advantage of Aloe vera over placebo for “clinical presentation total” and “RTOG total” were 3.97 (1.3–11.9) and 5.9 (1.6–21.6), respectively.
Conclusion: A substantial number of patients with radiation proctitis seem to benefit from therapy with Aloe vera 3% ointment.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Denton A, et al. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer 2002;87:134–143.
2.
Schultheiss TE, et al. Late GI and GU complications in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys 1997;37:3–11.
3.
Szepesi S, et al. Treatment of radiogenic colitis with a rectal foam containing cortisol. Clinical and pharmacologic data. Strahlenther Onkol 1990;166:271–274.
4.
Fischer L, et al. Late progress of radiation-induced proctitis. Acta Chir Scand 1989;156:801–805.
5.
Jensen DM, et al. A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Gastrointest Endosc 1997;45:20–25.
6.
Clarke RE, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: A randomized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 2008;72:134.e15–143.e15.
7.
Silva RA, et al. Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis. Gastrointest Endosc 1999;50:221–224.
8.
de Parades V, et al. Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis—An effective but not risk-free procedure: A prospective study of 33 patients. Dis Colon Rectum 2005;48:1535–1541.
9.
Tsujinaka S, et al. Formalin instillation for hemorrhagic radiation proctitis. Surg Innov 2005;12:123–128.
10.
Talley NA, et al. Short-chain fatty acids in the treatment of radiation proctitis. Dis Colon Rectum 1997;40:1046–1050.
11.
Kennedy M, et al. Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C. Am J Gastroenterol 2001;96:1080–1084.
12.
Maenthaisong R, et al. The efficacy of aloe vera used for burn wound healing: A systematic review. Burns 2007;33:713–718.
13.
Langmead L, Makins R, Rampton D. Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro. Aliment Pharmacol Ther 2004;19:521–527.
14.
Eshghi F, et al. Effects of Aloe vera cream on posthemorrhoidectomy pain and wound healing: Results of a randomized, blind, placebo-control study. J Altern Complement Med 2010;16:647–650.
15.
Khorasani G, et al. Aloe versus silver sulfadiazine creams for second-degree burns: A randomized controlled study. Surg Today 2009;39:587–591.
16.
Aghamohamamdi A, Hosseinimehr SJ. Natural products for management of oral mucositis induced by radiotherapy and chemotherapy. Integr Cancer Ther 2016;15:60–68.
17.
Yagi A, et al. Radical scavenging glycoprotein inhibiting cyclooxygenase-2 and thromboxane A2 synthase from aloe vera gel. Planta Med 2003;69:269–271.
18.
Vernia P, et al. Topical butyrate for acute radiation proctitis: Randomised, crossover trial. Lancet 2000;356:1232–1235.
19.
Rubin P. Special issue: Late effects of normal tissues consensus conference, including RTOG/EORTC SOMA scales. Int J Radiat Oncol Biol Phys 1995;31:1035–1360.
20.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–370.
21.
Hu Y, Xu J, Hu Q. Evaluation of antioxidant potential of Aloe vera (Aloe barbadensis Miller) extracts. J Agric Food Chem 2003;51:7788–7791.
22.
Yagi A, et al. Antioxidant, free radical scavenging and anti-inflammatory effects of aloesin derivatives in Aloe vera. Planta Med 2002;68:957–960.
23.
Baum CA, Biddle WL, Miner PB. Failure of 5-aminosalicylic acid enemas to improve chronic radiation proctitis. Dig Dis Sci 1989;34:758–760.
24.
Jahraus CD, et al. Prevention of acute radiation-induced proctosigmoiditis by balsalazide: A randomized, double-blind, placebo controlled trial in prostate cancer patients. Int J Radiat Oncol Biol Phys 2005;63:1483–1487.
25.
Babb RR. Radiation proctitis: A review. Am J Gastroenterol 1996;91:1309–1311.
26.
Venkitaraman R, et al. Pentoxifylline to treat radiation proctitis: A small and inconclusive randomised trial. Clin Oncol 2008;20:288–292.
27.
Cavciæ J, et al. Metronidazole in the treatment of chronic radiation proctitis: Clinical trial. Croat Med J 2000;4:314–318.
28.
Hovdenak N, Sørbye H, Dahl O. Sucralfate does not ameliorate acute radiation proctitis: Randomised study and meta-analysis. Clin Oncol 2005;17:485–491.
29.
Dees J, Meijssen MA, Kuipers EJ. Argon plasma coagulation for radiation proctitis. Scand J Gastroenterol 2006;41(Suppl. 243):175–178.
30.
Petkau A. Role of superoxide dismutase in modification of radiation injury. Br J Cancer Suppl 1987;8:87.
31.
Henriksson R, Franzen L, Littbrand B. Effects of sucralfate on acute and late bowel discomfort following radiotherapy of pelvic cancer. J Clin Oncol 1992;10:969–975.

Information & Authors

Information

Published In

cover image The Journal of Alternative and Complementary Medicine
The Journal of Alternative and Complementary Medicine
Volume 23Issue Number 11November 2017
Pages: 858 - 865
PubMed: 28618234

History

Published in print: November 2017
Published online: 1 November 2017
Published ahead of print: 15 June 2017

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Adeleh Sahebnasagh, PharmD, BCPS
Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Arash Ghasemi, MD
Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
Jafar Akbari, PhD
Pharmaceutical Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Abbas Alipour, MD, PhD
Faculty of Medicine, Community Medicine Department, Mazandaran University of Medical Sciences, Sari, Iran.
Hossein Lashkardoost, MSc
School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran.
Shahram Ala, PharmD, BCPS
Pharmaceutical Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
Ebrahim Salehifar, PharmD, BCPS
Gastrointestinal Cancer Research Center, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.

Notes

Address correspondence to:Ebrahim Salehifar, PharmD, BCPSGastrointestinal Cancer Research CenterDepartment of Clinical PharmacyFaculty of PharmacyMazandaran University of Medical SciencesKm 18 Khazarabad Road, Khazar SquareSari 48471-16548Mazandaran ProvinceIran
E-mail: [email protected]; [email protected]

Author Disclosure Statement

No competing financial interests exist.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top