Kokkonen Jorma, Möttönen Merja, Karttunen Tuomo J, Lanning Marjatta
Department of Pediatrics and Adolescence, Oulu University Hospital, Finland.
Pediatr Hematol Oncol. 2002 Apr-May;19(3):181-92. doi: 10.1080/088800102753541332.
Intensive chemotherapy (ICT) for a malignant disease in children may be associated with clinically significant mucosal lesions of the upper gastrointestinal tract. This prospective and randomized study was conducted to evaluate more thoroughly the mucosal damage and to find out whether vitamin A therapy might prevent the development of these lesions. Gastroduodenoscopy and non-invasive methods were used to examine a consecutive series of 20 patients (10 females, 10 males, aged 1-15 years) 4 weeks after initiating the therapy regimen. Half of the patients were randomized to take vitamin A supplements for 6 weeks. During a follow-up of 6 weeks, 13 (65%) reported some symptoms of the gastrointestinal (GI) tract, diarrhea and mouth pain being most prominent. Endoscopic abnormalities were found in 13 (65 %) subjects: esophagitis in 10, erosive duodenitis in 8, and gastritis in 7. Histologically, 11 subjects had duodenitis, 5 had gastritis, 3 had eosinophilic esophagitis, and 2 had lymphocytic esophagitis. Both endoscopic and histological abnormalities of the duodenum showed a close relationship with long-term (more than 2 weeks) granulocytopenia. The 4 patients with the most extensive endoscopic abnormalities were treated with HCl inhibitors, and re-endoscopy performed 4-8 weeks later showed complete recovery. The sugar permeability values, measured as the lactulose/mannitol ratio were comparable to the values obtained in the controls, and lactose intolerance was found in only 3 (20%) of the 15 children able to perform the breath test. Both the incidence of the reported GI symptoms and the endoscopically or histologically observed GI lesions were similar in the subjects randomized to take vitamin A supplements as in the controls. In this study, two-thirds of children with ICT showed erosive mucosal lesions of the upper gastrointestinal tract, and vitamin A therapy failed to prevent them. Endoscopic examination is recommended if a patient has severe symptoms indicative of mucosal pathology.
儿童恶性疾病的强化化疗（ICT）可能与临床上显著的上消化道黏膜病变有关。本前瞻性随机研究旨在更全面地评估黏膜损伤，并探究维生素A疗法是否可预防这些病变的发生。在开始治疗方案4周后，采用胃十二指肠镜检查和非侵入性方法对连续的20例患者（10名女性，10名男性，年龄1至15岁）进行检查。一半患者随机接受6周的维生素A补充剂治疗。在6周的随访期间，13例（65%）报告有一些胃肠道症状，其中腹泻和口腔疼痛最为突出。13例（65%）受试者发现内镜异常：食管炎10例，糜烂性十二指肠1炎8例，胃炎7例。组织学检查显示，11例受试者有十二指肠1炎，5例有胃炎，3例有嗜酸性食管炎，2例有淋巴细胞性食管炎。十二指肠的内镜和组织学异常均与长期（超过2周）粒细胞减少密切相关。4例内镜异常最严重的患者接受了盐酸抑制剂治疗，4至8周后再次进行内镜检查显示完全恢复。以乳果糖/甘露醇比值衡量的糖通透性值与对照组相当，在15例能够进行呼气试验的儿童中，仅3例（20%）发现乳糖不耐受。随机接受维生素A补充剂治疗的受试者与对照组相比，报告的胃肠道症状发生率以及内镜或组织学观察到的胃肠道病变相似。在本研究中，接受ICT治疗的儿童中有三分之二出现上消化道黏膜糜烂性病变，维生素A疗法未能预防这些病变。如果患者有提示黏膜病变的严重症状，建议进行内镜检查。
