Prospective study in the management of high dose radioactive iodine therapy-induced gastritis

• Main Authors: Carbonell, Christopher Anthony G., Santiago, Jonas Francisco Y., Ogbac, Ruben V., Magboo, Vincent Peter C.
• Format: text
• Published: Animo Repository 2010
• Subjects: Gastritis—Treatment; Iodine—Isotopes; Thyroid gland—Cancer; Medicine and Health Sciences
• Online Access: https://animorepository.dlsu.edu.ph/faculty_research/13436
• Institution: De La Salle University

The rationale for the study are the high percentage (observed prevalence of 65-67%) of clinical symptoms of therapy-induced radiation gastritis after radioactive iodine therapy and the varying methods and results with regard to its management. As of date, no local study has been made regarding the different treatment regimens. This study was undertaken to determine which treatment regime is suitable for radiation-induced gastritis. It also aims to compare the frequency of parameters such as nausea, vomiting and epigastric pain, among three different treatment groups (sucralfate, H2 receptor antagonist & proton pump inhibitors) in post-radioactive iodine ablation therapy, patients. METHODS: Forty-one patients who received 3700-7400MBq of radioactive 1-131 for well-differentiated thyroid cancer, regardless of age, extent of the disease or number of therapies done were included in this study. They were randomly grouped into three anti-gastritis treatment protocols of Sucralfate, H2-receptor antagonist, Proton-pump inhibitors. A randomly selected control group with no anti-gastritis medications given was also obtained. Patients who received <2960 MBq of I-131, previously diagnosed with gastritis, gastric ulcers and/or H.pylori ulcers and with maintenance medications of NSAIDS were excluded. Survey forms were distributed to evaluate the presence of nausea, vomiting, epigastric pain (graded according to severity of pain), and gastrointestinal bleeding.RESULTS: The following are incidences of the clinical symptoms attributed to radiation gastritis in each groups: Sucralfate-nausea (40%), vomiting (30%), epigastric pain (1.5, median score as graded by visual pain rating scale); H2-receptor antagonists-nausea (54%), vomiting (9%), epigastric pain (2) Control-nausea (20%), vomiting (10%), epigastric pain (0)CONCLUSION: High-dose radioactive iodine therapy is safe with minimal radiation gastritis symptoms. This is easily preventable by Sucralfate and appears to be a more appropriate medication for radiation-induced gastritis. Ranitidine, on the other hand, maybe used as an alternative medication if vomiting is already present. Additional subjects are needed to strengthen the claim in using Sucralfate as the first line of treatment for radiation gastritis. Further investigation of the role of Sucralfate in preventing deterministic and stochastic effects of high dose Iodine-131 therapy. Blinding of subjects is also recommended to further evaluate the control group.