Biomarkers and non-invasive tests for gastrointestinal mucositis

Abstract

Gastrointestinal mucositis is a complex inflammatory reaction of the mucous membranes, a side effect of both chemotherapy and radiotherapy. Currently, assessment scales are used to diagnose mucositis. However, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. This will give the opportunity to evaluate studies, to determine risk factors and incidence, and it will make it possible to compare studies. Moreover, this biomarker might improve clinical management for patients. In this paper, we reviewed studies concerning potential biomarkers in blood samples and fecal samples, and potential tests in breath samples and urine samples. We include biomarkers and tests studied in animal models and/or in clinical trials, and discuss the validity, diagnostic accuracy, and applicability.

Parenteral nutrition use in children with cancer

“…Although biomarkers hold promise for early identification of intestinal mucositis and possible intervention (e.g., timely placement of nasogastric tube prior to onset of severe mucositis or cytopenias), none of these tests are without limitation. They remain largely research based and inaccessible to most clinicians in clinical practice and are summarized briefly below …”

“…Plasma citrulline is a nonessential amino acid produced from glutamine in enterocytes, which can be used as a marker of functional small intestinal mucosal mass to reflect absorptive capacity. Low levels have been shown to correspond with severe mucosal barrier injury in patients undergoing HSCT . Isolated citrulline levels may have a role in differentiating site of gastrointestinal inflammation (small vs large bowel) in the absence of endoscopy and serial measurements can be used to monitor trends of cumulative small intestinal damage and progressive intestinal recovery/adaptation .…”

“…Breath tests such as the 13 C sucrose test measure expired breath 13CO 2 to reflect enterocyte absorptive digestive enzyme function, following ingestion of a sucrose load that is digested in the intestine and metabolized in the liver. A decreased amount of expired 13CO 2 occurs in the presence of gastrointestinal tract damage . Other proteins such as intestinal fatty acid binding protein (I‐FABP) and ileal bile acid binding protein (I‐BABP) have been proposed as biomarkers but require further research to determine their exact role and practicality for clinical use …”

“…A decreased amount of expired 13CO 2 occurs in the presence of gastrointestinal tract damage . Other proteins such as intestinal fatty acid binding protein (I‐FABP) and ileal bile acid binding protein (I‐BABP) have been proposed as biomarkers but require further research to determine their exact role and practicality for clinical use …”

“…EN is recommended as the nutritional strategy of choice in all patients with a functional gastrointestinal tract . It provides essential trophic factors to maintain gastrointestinal mucosa and when compared to PN, has been shown to have lower infection rates, less requirement for monitoring bloods, less cost, and can be easily administered as an outpatient .…”