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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2026, Número 1

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Rev Mex Coloproctol 2026; 22 (1)


Proctitis de origen actínico: revisión sistemática

Delgadillo X, Salgado G, Yanes B

Idioma: Español
Referencias bibliográficas: 61
Paginas: 18-32
Archivo PDF: 1811.16 Kb.


RESUMEN

Introducción: la proctitis inducida por radiación es una complicación frecuente y a menudo incapacitante de la radioterapia pélvica, especialmente en pacientes tratados por cánceres como el de próstata, cuello uterino y recto. Se presenta en formas aguda o crónica, con síntomas que van desde molestias leves hasta sangrado rectal severo, ulceraciones, fistulas y estenosis, afectando considerablemente la calidad de vida. A pesar de su alta prevalencia, las estrategias óptimas para su prevención y tratamiento siguen siendo motivo de debate. Objetivo: esta revisión sistemática tiene como objetivo evaluar la evidencia actual sobre la incidencia, fisiopatología, presentación clínica, métodos diagnósticos y opciones terapéuticas para la proctitis inducida por radiación, con énfasis en los avances recientes e intervenciones basadas en la evidencia. Material y métodos: se realizó una búsqueda exhaustiva en bases de datos como PubMed, Embase y Cochrane Library hasta marzo de 2025. Se incluyeron ensayos clínicos aleatorizados, estudios de cohortes y revisiones sistemáticas que abordaran casos de proctitis tras radioterapia pélvica. Los artículos fueron seleccionados según su relevancia y calidad metodológica siguiendo los lineamientos PRISMA y se evaluó el riesgo de sesgo. Resultados: se identificaron 80 estudios que cumplieron con los criterios de inclusión. La proctitis aguda suele aparecer en los primeros tres meses postrradioterapia y suele ser autolimitada, mientras que la forma crónica puede manifestarse meses o años después, requiriendo tratamientos más complejos. Las opciones terapéuticas incluyen agentes antiinflamatorios, enemas de sucralfato, aplicación de formalina, oxigenoterapia hiperbárica e intervenciones endoscópicas. Estudios recientes destacan el uso de probióticos, mesalazina y coagulación con plasma de argón. Técnicas preventivas como la radioterapia de intensidad modulada (IMRT) y los espaciadores rectales muestran eficacia en la reducción de casos. Conclusión: la proctitis inducida por radiación representa un reto clínico significativo. Nuevos tratamientos y estrategias preventivas prometen mejorar los resultados, aunque se requieren más estudios de alta calidad para establecer protocolos estandarizados.


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