Oral Glutamine Research Articles

Amino acids levels related to glutamine supplementation for type 2 diabetes patients

Aim: Amino acids levels are changed upon glutamine administration, but the impact of glutamine administration on plasma amino acid levels in type 2 diabetes patients remains unclear. Methods: A placebo controlled, randomized trial was performed with type 2 diabetic patients who consumed 2 supplements containing glutamine (10 g/3 times a day) or placebo (1 g/3 times a day) every day for 6 consecutive weeks. Blood samples were obtained just before initiation of study and again after the patients had received the study supplements. Results: Dietary supplementation with glutamine didn’t affect concentrations of plasma amino acid apart from for threonine. Plasma threonine concentration in intervention group was low at week 6 compared with placebo (glutamine group=111.19 ± 38.60 μmol/l, placebo group=135.30 ± 47.42 μmol/l; P=0.02). Conclusion: In type 2 diabetes patients, oral glutamine supplementation resulted in a decreased level of threonine.

Glutamine supplementation reduces markers of intestinal permeability during running in the heat in a dose-dependent manner

PurposeTo examine the dose–response effects of acute glutamine supplementation on markers of gastrointestinal (GI) permeability, damage and, secondary, subjective symptoms of GI discomfort in response to running in the heat.MethodsTen recreationally active males completed a total of four exercise trials; a placebo trial and three glutamine trials at 0.25, 0.5 and 0.9 g kg−1 of fat-free mass (FFM) consumed 2 h before exercise. Each exercise trial consisted of a 60-min treadmill run at 70% of dot {V}{{text{O}}_{{text{2max}}}} in an environmental chamber set at 30 °C. GI permeability was measured using ratio of lactulose to rhamnose (L:R) in serum. Plasma glutamine and intestinal fatty acid binding protein (I-FABP) concentrations were determined pre and post exercise. Subjective GI symptoms were assessed 45 min and 24 h post-exercise.ResultsRelative to placebo, L:R was likely lower following 0.25 g kg−1 (mean difference: − 0.023; ± 0.021) and 0.5 g kg−1 (− 0.019; ± 0.019) and very likely following 0.9 g kg− 1 (− 0.034; ± 0.024). GI symptoms were typically low and there was no effect of supplementation.DiscussionAcute oral glutamine consumption attenuates GI permeability relative to placebo even at lower doses of 0.25 g kg−1, although larger doses may be more effective. It remains unclear if this will lead to reductions in GI symptoms. Athletes competing in the heat may, therefore, benefit from acute glutamine supplementation prior to exercise in order to maintain gastrointestinal integrity.

SUN-P090: Comparison of the Impact of Oral Glutamine and Hypercaloric Oral Nutritional Supplementation in Lung Cancer Patients Treated with Radiotherapy +/− Chemotherapy

SUN-P090: Comparison of the Impact of Oral Glutamine and Hypercaloric Oral Nutritional Supplementation in Lung Cancer Patients Treated with Radiotherapy +/− Chemotherapy

IMMUNONUTRITION WITH GLUTAMINE IN ICU PATIENTS

Objective: Endogenous production of glutamine may be reduced during critical illness. The shortage of glutamine is reflected as a decrease in plasma concentration, which is a prognostic factor for outcome in sepsis. Therefore, we have studied the effect of enteral or parenteral glutamine therapy on biochemical parameters and the hospital stay of critically ill patients.Methods: A total of 66 critically ill patients aged 18-70 years, admitted to central and medical intensive care unit of a tertiary care hospital were randomly divided into three equal groups; 22 in each group: Group 1 (control group) received no glutamine, Group 2 received oral glutamine 0.5 g/kg/d for 5 days, and Group 3 received parenteral glutamine 0.5 g/kg/d by intravenous infusion for 5 days. All patients received glutamine-free tube feed throughout the study period. Total leukocyte count (TLC), total lymphocyte count, total protein and serum albumin, serum lactate, and sequential organ failure assessment (SOFA) score were recorded on each day for 7 days and were compared.Results: Decrease in the TLC and increase in lymphocyte count was most evident in Group 3 compared to Groups 2 and 1 which was statistically significant. Decrease in serum lactate and increase in serum protein and albumin was maximum in Group 3 compared to Groups 1 and 2 which was statistically significant. The mean duration of hospital stay of Group 3 was the least followed by Groups 2 and 1 which was statistically not significant. There was an improvement in SOFA score in all the three groups.Conclusion: Parenteral glutamine in a dose of 0.5 g/kg/d was more potent than oral glutamine in improving the biochemical parameters. The duration of hospital stay was similar in all the groups after treatment.

Glutamine supplementation suppresses herpes simplex virus reactivation.

Chronic viral infections are difficult to treat, and new approaches are needed, particularly those aimed at reducing reactivation by enhancing immune responses. Herpes simplex virus (HSV) establishes latency and reactivates frequently, and breakthrough reactivation can occur despite suppressive antiviral therapy. Virus-specific T cells are important to control HSV, and proliferation of activated T cells requires increased metabolism of glutamine. Here, we found that supplementation with oral glutamine reduced virus reactivation in latently HSV-1-infected mice and HSV-2-infected guinea pigs. Transcriptome analysis of trigeminal ganglia from latently HSV-1-infected, glutamine-treated WT mice showed upregulation of several IFN-γ-inducible genes. In contrast to WT mice, supplemental glutamine was ineffective in reducing the rate of HSV-1 reactivation in latently HSV-1-infected IFN-γ-KO mice. Mice treated with glutamine also had higher numbers of HSV-specific IFN-γ-producing CD8 T cells in latently infected ganglia. Thus, glutamine may enhance the IFN-γ-associated immune response and reduce the rate of reactivation of latent virus infection.

Treatment of acute pouchitis

Acute pouchitis is a common disease that affects many patients with an ileal pouch-anal anastomosis. The management of acute pouchitis remains largely empiric with the mainstay of therapy being the antibiotics ciprofloxacin and metronidazole. Probiotics may have a role in the primary and secondary prophylaxis of acute pouchitis. In addition, there are modest data that probiotics are effective in the treatment of mild acute pouchitis. There are limited data for other treatments of acute pouchitis including oral and rectal budesonide and glutamine suppositories. Diet plays a largely undefined role in the development and management of acute pouchitis, and, although many have been studied, no specific diet can currently be recommended. Larger well-designed clinical trials are necessary to confirm the efficacy of current treatments and to investigate new treatments for the management of acute pouchitis.

Double-blind randomized study of oral glutamine on the management of radio/chemotherapy-induced mucositis and dermatitis in head and neck cancer.

This randomized clinical trial was designed to determine whether glutamine administration was effective in reducing the incidence and severity of mucositis and dermatitis induced by radiotherapy (RT) or chemoradiotherapy (CHRT) in patients with head and neck cancer (HNC). Fifty patients were randomized to receive orally either L-Glutamine or placebo (25 patients in each arm). In the glutamine-treated group, 10 g of oral glutamine was administered three times daily. The primary endpoint was to compare the appearance of clinical mucositis between groups at the 6th week, according to the Common Terminology Criteria for Adverse Events. Secondary endpoints were: Functional mucositis, mucositis onset, cervicofacial dermatitis, pain, weight loss and assessment of quality of life (according to the M.D. Anderson Symptom Inventory-Head and Neck). In total, 76 and 87.5% developed clinical mucositis in the glutamine and placebo group, respectively. The incidence and severity grade of mucositis at the 6th week did not exhibit statistically significantly differences between the two groups, although it had a higher value in the placebo group. Significant reduction of dermatitis incidence (P=0.038) and severity (P=0.032) was found in the glutamine group. There were no differences in other outcomes such as pain, weight loss and mucositis onset, in treatment parameters including concomitant chemotherapy, radiation dose and previous surgery, or in quality of life. The present study revealed that glutamine provided slight clinical effects compared with placebo in terms of reducing oral mucositis induced by RT or CHRT in patients with HNC at the 6th week; however, the results were not statistically significant. Although the findings suggested a significant benefit in reducing the incidence and severity of dermatitis, further confirmatory studies are required.

Oral glutamine reduces myocardial damage after coronary revascularization under cardiopulmonary bypass. A randomized clinical trial.

Glutamine is the most abundant free amino acid in the body. It modulates immune cell function and is an important energy substrate for cells in critically ill patients. Reduction of injury cardiac markers had been observed in patients receiving intravenous glutamine and in a pilot study with oral glutamine. The aim of this study was to analyze the effect of preoperative oral supplementation of glutamine on postoperative serum levels of cardiac injury markers. A randomized clinical trial was performed in 28 Mexican patients with ischemic heart disease who underwent cardiopulmonary bypass with extracorporeal circulation. Patients were randomly assigned to receive oral glutamine (0.5 g/kg/day) or maltodextrin 3 days before surgery. Cardiac injury markers as troponin-I, creatine phosphokinase, and creatine phosphokinase-Mb were measured at 1, 12, and 24 hours postoperatively. At 12 and 24 hours serum markers levels were significantly lower in the glutamine group compared with controls (p = 0.01 and p = 0.001, respectively) (p = 0.004 and p < 0.001, respectively). Overall, complications were significantly lower in the glutamine group (p = 0.01, RR = 0.54, 95% CI 0.31-0.93). Mortality was observed with 2 cases of multiple organ failure in control group and 1 case of pulmonary embolism in glutamine group (p = 0.50). Preoperative oral glutamine standardized at a dose of 0.5 g/kg/day in our study group showed a significant reduction in postoperative myocardial damage. Lower cardiac injury markers levels, morbidity and mortality were observed in patients receiving glutamine.

A Comparison of Oral and Intravenous Glutamine Therapy Effects On Mucositis Development in Acute Leukemic Patients After High Dose Chemotherapy Supplementation

Aim: We compared the oral and intravenous glutamine therapy effects on mucositis development in acute leukemia patients after high dose chemotherapy supplementation. This research was applied in high dose chemotherapy patients in order to determine the effects of parenteral glutamine support on mucositis development. The results of oral and parenteral glutamine therapy are compared and analyzed for variations in mucositis formation. Materials and Methods: The present study includes the results of glutamine therapy performed on two patient groups. A total of 70 individuals (33 female and 37 male) were included in the study. Out of these patients, 35 were given oral glutamine whereas the remaining 35 were given glutamine via an intravenous route following chemotherapy. Patients were between 16 and 71 years of age. IV-therapy and oral therapy patients were selected as first and second groups, respectively. The same amount of Lalanyl Glutamine solution was given to both groups in equal time intervals. Mucositis grading was performed according to the criteria of the American Academy of Pediatric Dentistry and staging was carried out according to oral mucositis index. Results: When records of both groups were analyzed seperately, mild to moderate mucositis was determined in 85.7% (30 of 35) of the patients whereas severe mucositis was observed in 14.3% (5 of 35) patients who received oral glutamine support. On the other hand, mild- to moderate mucositis developed in all 35 patients (100%) who received intravenous glutamine support, but no severe mucositis developed in those patients. Conclusion: The result of this work can be summarized as; neither oral nor parenteral glutamine therapy prevents mucosite development, but parenteral glutamine therapy has a preventative effect on the development of severe mucositis.

FRI-026 - Oral glutamine challenge predicts risk and defines hepatic encephalopathy types

FRI-026 - Oral glutamine challenge predicts risk and defines hepatic encephalopathy types

Effects Of Oral Glutamine on Inflammatory and Autophagy Responses in Cancer Patients Treated With Abdominal Radiotherapy: A Pilot Randomized Trial.

Background and Aims: Abdominal radiotherapy (RT) causes harm to the mid gastrointestinal mucosa by release of pro-inflammatory cytokines and promotes autophagic changes in tumor cells. This study was aimed to measure the effect of glutamine administration on markers of inflammation and autophagy in cancer patients treated with RT.Methods: In this double-blind, randomized, controlled pilot trial 43 patients under abdominal RT diagnosed of pelvic or abdominal malignancies receiving glutamine (30 g/d) or placebo (casein, 30 g/d). Patient recruitment took place in the Complejo Asistencial Universitario of León (CAULE), Spain. Patient evaluation took place at three different time points during the study: before RT (pre-treatment), in the middle of the RT period (mid-treatment), and after finishing RT (post-treatment). Data were compared by analysis of variance and the Newmann Keuls test. Significance was accepted at p < 0.05.Results Abdominal RT increased whole blood mRNA levels of inflammatory and autophagic markers, but glutamine administration showed significantly lower expression of toll-like receptor 4 (TLR4), CD36, interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), cyclooxygenase-2 (COX-2), and matrix metalloproteinase-9 (MMP-9). Moreover, glutamine reduced the expression of the transcription factors nuclear factor kappa B (NF-κB) and activator protein 1 (AP-1). Glutamine also inhibited the autophagic response, with changes in expression of beclin-1, UV radiation resistance associated gene (UVRAG), autophagy-related protein-5 (Atg5), protein 1 light chain 3 (LC3), sequestosome 1 (p62/SQSTM1) and lysosome-associated membrane protein (LAMP)-1.Conclusions Findings provide evidence that glutamine decreases the inflammatory response and abolishes the changes of the autophagy machinery in patients receiving abdominal RT. The protective effect of glutamine must continue being investigated to disclose further molecular pathways.

Dietary glutamine supplementation enhances endothelial progenitor cell mobilization in streptozotocin-induced diabetic mice subjected to limb ischemia

Diabetes is a metabolic disorder with increased risk of vascular diseases. Tissue ischemia may occur with diabetic vascular complications. Bone marrow-derived endothelial progenitor cells (EPCs) constitute a reparative response to ischemic injury. This study investigated the effects of oral glutamine (GLN) supplementation on circulating EPC mobilization and expression of tissue EPC-releasing markers in diabetic mice subjected to limb ischemia. Diabetes was induced by a daily intraperitoneal injection of streptozotocin for 5 days. Diabetic mice were divided into 2 nonischemic groups and 6 ischemic groups. One of the nonischemic and 3 ischemic groups were fed the control diet, while the remaining 4 groups received diets with identical components except that part of the casein was replaced by GLN. The respective diets were fed to the mice for 3 weeks, and then the nonischemic mice were sacrificed. Unilateral hindlimb ischemia was created in the ischemic groups, and mice were sacrificed at 1, 7 or 21 days after ischemia. Their blood and ischemic muscle tissues were collected for further analyses. Results showed that plasma matrix metallopeptidase (MMP)-9 and the circulating EPC percentage increased after limb ischemia in a diabetic condition. Compared to groups without GLN, GLN supplementation up-regulated plasma stromal cell-derived factor (SDF)-1 and muscle MMP-9, SDF-1, hypoxia-inducible factor-1 and vascular endothelial growth factor gene expression. The CD31-immunoreactive intensities were also higher in the ischemic limb. These findings suggest that GLN supplementation enhanced circulating EPC mobilization that may promote endothelium repair at ischemic tissue in diabetic mice subjected to limb ischemia.

Does oral glutamine improve insulin sensitivity in adolescents with type 1 diabetes?

ObjectiveThe decline in insulin sensitivity (SI) associated with puberty increases the difficulty of achieving glycemic control in adolescents with type 1 diabetes (T1D). The aim of this study was to determine whether glutamine supplementation affects blood glucose by enhancing SI in adolescents with T1D. MethodsThirteen adolescents with T1D (HbA1C 8.2 ± 0.1%) were admitted to perform afternoon exercise (four 15-min treadmill/5-min rest cycles of exercise) on two occasions within a 4-wk period. They were randomized to receive a drink containing either glutamine (0.25 g/kg) or placebo before exercise, at bedtime, and early morning in a double-blind, crossover design. Blood glucose was monitored overnight, and a hyperinsulinemic-euglycemic clamp was performed the following morning. ResultsBlood glucose concentration dropped comparably during exercise on both days. However, the total number of nocturnal hypoglycemic events (17 versus 7, P = 0.045) and the cumulative probability of overnight hypoglycemia (50% versus 33%, P = 0.02) were higher on the glutamine day than on the placebo day. During clamp, glucose infusion rate was not affected by glutamine supplementation (7.7 ± 1 mg • kg−1 • min−1 versus 7.0 ± 1; glutamine versus placebo; P = 0.4). ConclusionsOral glutamine supplementation decreases blood glucose in adolescents with T1D after exercise. Insulin sensitivity, however, was unaltered during the euglycemic clamp. Although the mechanisms involved remain to be elucidated, studies to explore the potential use of glutamine to improve blood glucose control are needed.

The effects of oral glutamine on clinical and survival outcomes of non-small cell lung cancer patients treated with chemoradiotherapy

To assess the efficacy of oral glutamine (Gln) supplementation on clinical and survival outcomes of patients with locally advanced non-small cell lung cancer (LA-NSCLC). Between 2010 and 2014, 122 stage III NSCLC patients were retrospectively analyzed. All patients received curative intent chemoradiotherapy (CRT). Prophylactic oral Gln powder was applied at a dose of 10g tid. Effect of oral Gln supplementation in the prevention of severe (≥grade 2-3) acute radiation-induced esophagitis (ARE) and weight loss, and their relation with overall survival (OS) and disease-free survival (DFS) was measured. Median follow-up was 13.14 months (range; 1.97-55.36). Fifty-six (46%) patients had received oral Gln. Severe ARE was significantly lower in Gln-supplemented group (30% vs 70%; p=0.002). Gln-free patients demonstrated a higher weight loss (p=0.0001). In multivariate analysis hemoglobin (hb) level (<12g/dL; p=0.01) and nodal stage (N3; p=0.01) were poor prognostic factors that affect OS; Weight loss (p=0.06) and Gln-free (p=0.05) reached nearly significant levels that poorly affect OS. Similarly, nodal stage (N3, p=0.014) and Gln-free (p=0.035) were poor prognostic factors that affect DFS. Weight loss (≥2%, p=0.06) and hb level (<12g/dL, p=0.07) reached borderline significance that poorly affect DFS. Nodal stage (N3) was the only poor prognostic factor that affect OS and DFS in univariate analysis (p=0.01, p=0.009; respectively). Oral Gln supplementation significantly reduces grade 2-3 esophagitis and weight loss and also no negative impact on tumor control and survival outcomes in patients with LA-NSCLC.

Chemopreventive Effect of Dietary Glutamineon Colitis-Associated Colorectal Cancer Is Associated with Modulation of the DEPTOR/mTOR Signaling Pathway.

Glutamine plays a protective role in colitis and colitis-associated colorectal cancer (CAC); however, the protective mechanisms are largely unknown to date. DEP domain-containing mTOR-interacting protein (DEPTOR)/mammalian Target of Rapamycin (mTOR) signaling plays an important role in carcinogenesis. The present study investigated the potential molecular mechanisms for the protective effect of glutamine in a murine model of azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced CAC. The effects of glutamine on DEPTOR/mTOR signaling and protein light chain 3 (LC3) were evaluated. Administration of glutamine was associated with attenuated development of CAC. Increased expression of DEPTOR and decreased expressions of factors of mTOR signaling, including phospho-mTOR, phospho-STAT3, phospho-Akt, and phospho-S6, were observed in AOM/DSS mice administered glutamine. Furthermore, oral glutamine was associated with increased LC3-II expression in AOM/DSS mice. The present study indicates that regulation of DEPTOR/mTOR signaling may be an important mechanism for glutamine in prevention against the development of CAC. In addition, the chemopreventive effect of dietary glutamine on CAC is, at least in part, associated with the induction of autophagy.

Randomized study of nutritional status and treatment toxicities of oral arginine, glutamine, and Omega-3 fatty acids during concurrent chemoradiotherapy for head and neck cancer patients

Background: Patients with head and neck cancer (HNC) undergoing concurrent chemoradiotherapy (CCRT) are at high risk of dysphagia, malnutrition, and immunosuppression. Arginine, glutamine, and Omega-3 fatty acidsare immune-enhanced nutrition that can promote cellular immunity.We aimed to examine the impact of immunonutrition diet on nutritional status, and CCRT toxicities, in this group of patients.Methods: Forty patients with HNC who treated with curative CCRT were randomized to: group A (n = 20), patients who received a regular diet and dietary counselingby a protocol dietician; group B (n = 20), patients who received a regular diet plus immune-enhanced nutrition supplements and dietary counseling by the same protocol dietician. Outcome measures were weight loss, protein and energy intake, serum pre-albumin and albumin, and toxicities of CCRT were evaluated at baseline, weekly and at the end of treatment.Results:Both groups were well balanced at baseline.One patient from group A (1/20) withdrew consent. Seven patients from group B (7/20) withdrew from the study; 1 patient could not tolerate the side effect of chemotherapy and 6 patients could not tolerate the taste of oral immune-enhanced nutrition.A significant loss in total body weight was observed in group A patients (p&lt;0.001), whereas not significant loss in group B (p=0.109). Median percentage change from baseline of energy intake was 19.6%, and 22.9% at the end of treatment for group A, and B, respectively. The circulating levels of nutritional markers, pre-albumin and albumin decreased after CCRT in both groups. There was a significantly decreased level of albumin in group A more than group B, at the end of treatment. During CCRT; 4 patients (20%) in group A and 1 patient(5%) in group B developed grade 3 mucositis, respectively. One patient (5%) in group A had grade 3 radiation dermatitis. Grade 3 – 4 hematologic toxicities, mainly in absolute neutrophil count (ANC) were significant higher in group A than group B; 20% versus 0% (p=0.035).Over the 7-week period of CCRT, both intention to treat analysis and per protocol analysis revealed similar in scaled for all endpoints.Conclusions: Nutritional counseling and immuno-nutrition can reduce the deterioration of nutrition status and also significantly reduced hematologic and non-hematologic toxicity of CCRT in head and neck cancer.Keywords : immune-enhanced nutrition, concurrent chemoradiotherapy, head and neck cancer

Glutamine metabolism in advanced age.

Glutamine, reviewed extensively in the last century, is a key substrate for the splanchnic bed in the whole body and is a nutrient of particular interest in gastrointestinal research. A marked decrease in the plasma glutamine concentration has recently been observed in neonates and adults during acute illness and stress. Although some studies in newborns have shown parenteral and enteral supplementation with glutamine to be of benefit (by decreasing proteolysis and activating the immune system), clinical trials have not demonstrated prolonged advantages such as reductions in mortality or risk of infections in adults. In addition, glutamine is not able to combat the muscle wasting associated with disease or age-related sarcopenia. Oral glutamine supplementation initiated before advanced age in rats increases gut mass and improves the villus height of mucosa, thereby preventing the gut atrophy encountered in advanced age. Enterocytes from very old rats continuously metabolize glutamine into citrulline, which allowed, for the first time, the use of citrulline as a noninvasive marker of intestinal atrophy induced by advanced age.

The Impact of Oral Glutamine Supplementation on Prevention of Nosocomial Infections in Preterm Infants

Background: In the recent decades, the prevalence of nosocomial infections in neonates has grown and almost 21% of preterm neonates experience these kinds of infections. Some factors were proposed to have a protective effect against neonatal infections through promoting the development of the immune system of the newborn. This study aimed to evaluate the efficacy of oral glutamine supplementation in management of neonatal sepsis. Methods: Neonates were randomly allocated to case and control groups. The infants in the case group received 0.3 g/kg/day glutamine, every eight hours from three days of age to 28 days. Hospital stay duration and occurrence of necrotizing enterocolitis (NEC) as well as sepsis were recorded for each patient. Data were analyzed using SPSS version 16. Results: In general, 105 neonates were enrolled in the study, 52 of who were allocated to the glutamine group and 53 neonates assigned to the control group. The results showed that 52 (49.5%) cases were male and 53 (50.6%) were female with mean gestational age of 30±2 weeks. Life threatening infections occurred more commonly in the control group (P=0.036). Six neonates (11.5 %) in the glutamine group and eight (15.1 %) in the control group developed clinical sepsis (P=0.592). NEC occurred only in the control group (P=0.118). Mean durations of hospital stay in the glutamine and placebo groups were 20±12 days and 26±18 days (P=0.065), respectively. Mean durations of oxygen therapy were 6±5 days and 16±11 days for the glutamine and control groups, respectively (P=0.039). Conclusion: Oral glutamine administration reduced life threatening infections and duration of receiving supplemental oxygen.

Management of Chemoradiation-Induced Mucositis in Head and Neck Cancers With Oral Glutamine.

PurposeHead and neck cancers are the third most common cancers worldwide. Oral mucositis is the most common toxicity seen in patients who receive chemoradiation to treat head and neck cancer. The aim of this study was to evaluate the efficacy and safety of oral glutamine supplementation in these patients.Materials and MethodsFrom December 2013 to December 2014, we randomly assigned to two arms 162 patients who had squamous cell carcinoma of the head and neck. Patients in arm A were given oral glutamine once per day, whereas those in arm B served as negative control subjects. All patients received radiotherapy given as 70 Gy in 35 fractions over 7 weeks with an injection of cisplatin once per week. Patients were assessed once per week to evaluate for the onset and severity of mucositis, pain, use of analgesics, and for Ryle tube feeding.ResultsWe observed that 53.1% of patients developed mucositis toward the fifth week in the glutamine arm compared with 55.5% of patients in the control arm at the third week. None in the glutamine arm compared with 92.35% of patients in the control arm developed G3 mucositis. Rates of adverse events like pain, dysphagia, nausea, edema, and cough, as well as use of analgesics and Ryle tube feeding, were significantly lower in the glutamine arm than in the control arm.ConclusionThis study highlights that the onset as well as the severity of mucositis in patients receiving glutamine was significantly delayed. None of the patients receiving glutamine developed G3 mucositis. Hence, the findings emphasize the use of oral glutamine supplementation as a feasible and affordable treatment option for mucositis in patients with head and neck cancers who are receiving chemoradiation.

Treatment of oral mucositis due to chemotherapy.

IntroductionThe management of oral mucositis is a challenge, due to its complex biological nature. Over the last 10 years, different strategies have been developed for the management of oral mucositis caused by chemotherapy in cancer patients.Material and MethodsAn exhaustive search was made of the PubMed-Medline, Cochrane Library and Scopus databases, crossing the key words “oral mucositis”, “prevention” and “treatment” with the terms “chemotherapy” and “radiotherapy” by means of the boolean operators “AND” and “NOT”. A total of 268 articles were obtained, of which 96 met the inclusion criteria.ResultsSeveral interventions for the prevention of oral mucositis, such as oral hygiene protocols, amifostine, benzidamine, calcium phosphate, cryotherapy and iseganan, among others, were found to yield only limited benefits. Other studies have reported a decrease in the appearance and severity of mucositis with the use of cytoprotectors (sucralfate, oral glutamine, hyaluronic acid), growth factors, topical polyvinylpyrrolidone, and low power laser irradiation.ConclusionsVery few interventions of confirmed efficacy are available for the management of oral mucositis due to chemotherapy. However, according to the reviewed literature, the use of palifermin, cryotherapy and low power laser offers benefits, reducing the incidence and severity of oral mucositis – though further studies are needed to confirm the results obtained. Key words:Chemotherapy-Induced Oral Mucositis Treatment.