Arends Jann
Department of Medicine I, Medical Center - University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
Curr Opin Support Palliat Care. 2018 Jun;12(2):168-173. doi: 10.1097/SPC.0000000000000345.
Gastrointestinal mucositis is a frequent side effect of systemic anticancer treatment and radiotherapy. The occurrence endangers body resources by decreasing food intake and absorption. This review highlights new developments in treatment and prevention.
Recent clinical practice guidelines recommend supplying adequate amounts of energy and nutrients to cancer patients undergoing anticancer treatments. This requires repeated screening for risk of malnutrition and in at-risk patients, assessment of food intake and nutritional status, followed by nutritional interventions targeted at individual deficiencies and tolerance to oral, enteral or parenteral feeding. Recent preclinical data report beneficial effects of stimulating the sensor for cell damage signals TRPA1, blocking histamine H2 receptors or supplying probiotics. In a recent clinical trial, amifostine reduced gastrointestinal symptoms and was well tolerated. Probiotics are studied in ongoing clinical trials and glucagon-like peptide 2 analogues are considered for future trials. Due to limited options available today, it has been suggested to also consider several plant-based complementary therapies.
Although options for prevention and treatment of chemotherapy or radiotherapy-induced gastrointestinal mucositis today are still limited, inadequate energy and nutrient intake should trigger nutritional interventions, including counselling, oral nutritional supplements, tube feeding and parenteral nutrition. To prevent gastrointestinal mucositis, several new agents have shown promising results in preclinical trials.
胃肠道黏膜炎是全身抗癌治疗和放射治疗常见的副作用。其发生通过减少食物摄入和吸收危及身体资源。本综述重点介绍治疗和预防方面的新进展。
近期临床实践指南建议为接受抗癌治疗的癌症患者提供充足的能量和营养。这需要对营养不良风险进行反复筛查，对于有风险的患者，评估食物摄入量和营养状况，随后针对个体缺乏情况以及对口服、肠内或肠外营养的耐受性进行营养干预。近期临床前数据报道了刺激细胞损伤信号传感器TRPA1、阻断组胺H2受体或提供益生菌的有益效果。在一项近期临床试验中，氨磷汀减轻了胃肠道症状且耐受性良好。益生菌正在进行临床试验研究，胰高血糖素样肽2类似物被考虑用于未来试验。鉴于目前可用选择有限，有人建议也考虑几种基于植物的辅助疗法。
尽管目前化疗或放疗引起的胃肠道黏膜炎的预防和治疗选择仍然有限，但能量和营养摄入不足应引发营养干预，包括咨询、口服营养补充剂、管饲和肠外营养。为预防胃肠道黏膜炎，几种新药物在临床前试验中已显示出有前景的结果。
