Adelaide Medical School, University of Adelaide, Adelaide, Australia.
Division of Health Sciences, University of South Australia, Adelaide, Australia.
Support Care Cancer. 2019 Oct;27(10):4011-4022. doi: 10.1007/s00520-019-04892-0. Epub 2019 Jul 8.
The aim of this study was to update the clinical practice guidelines for the use of agents for the prevention and/or treatment of gastrointestinal mucositis (GIM).
A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, and No Guideline Possible.
A total of 78 papers across 13 interventions were examined of which 25 were included in the final review. No new guidelines were possible for any agent due to inadequate and/or conflicting evidence. Existing guidelines for probiotics and hyperbaric oxygen were unchanged.
Of the agents studied for the prevention and treatment of GIM, the evidence continues to support use of probiotics containing Lactobacillus spp. for prevention of chemoradiotherapy and radiotherapy-induced diarrhea in patients with pelvic malignancy, and hyperbaric oxygen therapy to treat radiation-induced proctitis. Additional well-designed research is encouraged to enable a decision regarding palifermin, glutamine, sodium butyrate, and dietary interventions, for the prevention or treatment of GIM.
本研究旨在更新预防和/或治疗胃肠道黏膜炎（GIM）的药物临床实践指南。
由多国支持治疗癌症协会/国际口腔肿瘤学会（MASCC/ISOO）的黏膜炎研究小组进行了系统评价。为每个癌症治疗环境中的每个干预措施的证据体分配了一个证据级别。根据证据水平，可以做出以下三种指南决定之一：推荐、建议和无法制定指南。
共检查了 13 种干预措施的 78 篇论文，其中 25 篇被纳入最终综述。由于证据不足和/或相互矛盾，没有新的指南可以制定任何药物。益生菌和高压氧的现有指南保持不变。
在所研究的预防和治疗 GIM 的药物中，含有乳杆菌属的益生菌预防盆腔恶性肿瘤患者的放化疗和放疗引起的腹泻以及高压氧治疗放射性直肠炎的证据仍然支持使用。鼓励进行更多精心设计的研究，以确定 palifermin、谷氨酰胺、丁酸钠和饮食干预措施在预防或治疗 GIM 中的作用。
