Elemental diet plus glutamine for the prevention of mucositis in esophageal cancer patients receiving chemotherapy: a feasibility study

Abstract

Purpose We investigated the effect of glutamine (Gln) and an elemental diet (ED) on chemotherapy-induced oral mucositis in esophageal cancer patients. Methods Thirty patients were randomized to the control group (no treatment: n = 10), Gln group (oral intake of 8910 mg Gln/day: n = 10), or Gln plus ED group (total oral intake of 8862 mg Gln/day, including the Gln in ED: n = 10). Oral administration of Gln and ED began 1 week before chemotherapy and continued during treatment. Oral mucositis was evaluated during 2 cycles of chemotherapy using Common Terminology Criteria for Adverse Events v3.0. Results The incidence of grade ≥2 oral mucositis was 60 % in the control group, 70 % in the Gln group, and 10 % in the Gln plus ED group. Gln plus ED showed a significant preventive effect on the development and severity of oral mucositis. By multivariate analysis, Gln plus ED and cancer stage were independent factors affecting chemotherapy-induced oral mucositis. The percentage of change in body weight and diamine oxidase activity from before chemotherapy was higher in the Gln plus ED group than in the control group.Conclusions Oral administration of Gln plus ED may prevent chemotherapy-induced oral mucositis in esophageal cancer patients.

Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta‐analysis of randomized clinical trials

“…Thus, 39 articles remained for full‐text reading for eligibility (phase 2), and 27 studies were then excluded. In total, 12 articles were selected for data extraction and qualitative synthesis. Figure details this process of study selection.…”

“…All studies were reports of randomized clinical trials, published in the English language, between 2004 and 2018. The studies were divided by subgroups according to the following interventions: elental, glutamine, and zinc …”

“…The oral supplementations used as controls were placebo, maltodextrin, soybean oil and no treatment . 7 studies included patients undergoing chemoradiotherapy, 7 evaluated samples with patients undergoing RT, and 4 studies assessed patients undergoing CH …”

“…8 studies included patients with head and neck cancer, 2 studies included only patients with esophageal cancer in the sample, 1 study included patients with leukemia, and only 1 study included patients with multiple types of cancer. The descriptive characteristics of the included articles are summarized in Table .…”

“…7 studies were classified as having an unclear risk of bias because at least 1 domain was unclear. 3 studies were classified as high risk of bias due to at least 1 domain with a high risk of bias, especially in terms of selection bias and incomplete or non‐blinding of the participants, and the outcome was likely influenced by the lack of blinding.…”