title: The effect of oral glutamine on 5-fluorouracil/leucovorin-induced mucositis/stomatitis assessed by intestinal permeability test.
abstract: OBJECTIVE
  Systemic chemotherapy may damage gastrointestinal epithelium. Mucositis is associated with increased intestinal permeability (IP). It is known that IP test with chromium 51-ethylene diaminetetra-acetate (51Cr-EDTA) is a useful tool to assess the mucositis. Oral glutamine supplements (OGS) may have a role in the prevention of chemotherapy-induced mucositis/stomatitis. The aim of this study was to characterize the relationship between the urinary excretion of 51Cr-EDTA and the severity of mucositis, and the effect of OGS on 5-fluorouracil/leucovorin (FU/LV)-induced mucositis/stomatitis.
  
  
  METHODS
  Fifty-one patients with advanced or metastatic cancer received FU/LV chemotherapy. The control group included 18 healthy volunteers. IP was assessed via the measurement of 51Cr-EDTA urinary excretion after oral challenge, on days 7 after the discontinuation of chemotherapy. Of the 51 patients, 22 patients received OGS (30 g/day) and 29 received only best supportive care (BSC). Glutamine supplementation continued for 15 days. It was initiated at least 3 days before the beginning of chemotherapy. Mucositis/stomatitis was graded according to version 3.0 of the Common Terminology Criteria for Adverse Events.
  
  
  RESULTS
  In the chemotherapy group, the median (25 percentile, 75 percentile) IP test score was significantly higher than those of the control group [6.78% (4.63, 10.66) vs. 2.17% (1.38, 2.40), P<0.001]. The severity of stomatitis was significantly correlated with IP test scores (r=0.898, P<0.001). In the OGS group, the median IP test score was significantly lower than that of the BSC group [4.69% (3.10, 6.48) vs. 8.54% (6.48, 15.31), P<0.001]. A mucositis/stomatitis of grade 2-4 was observed in two patients of the OGS group (9%), and in 11 patients (38%) in the BSC group (P<0.001).
  
  
  CONCLUSIONS
  The IP test may be a useful tool in the evaluation of mucositis/stomatitis. OGS may exert a protective effect on FU/LV-induced mucositis/stomatitis. Further studies, however, will be necessary to define the role of glutamine supplementation in FU/LV-induced mucositis/stomatitis.
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, Republic of Korea.
authors.forename: Kwon
authors.initials: K
authors.lastname: Choi
authors.forename: Seung Sei
authors.initials: SS
authors.lastname: Lee
authors.forename: Suk Joong
authors.initials: SJ
authors.lastname: Oh
authors.forename: Seong Yong
authors.initials: SY
authors.lastname: Lim
authors.forename: Si Young
authors.initials: SY
authors.lastname: Lim
authors.forename: Woo Kyu
authors.initials: WK
authors.lastname: Jeon
authors.forename: Tae Yun
authors.initials: TY
authors.lastname: Oh
authors.forename: Jeong Wook
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002860:Chromium Radioisotopes; D004492:Edetic Acid / Q000652:urine*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D005973:Glutamine / Q000494:pharmacology*; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D002955:Leucovorin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced / Q000473:pathology* / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy; D010539:Permeability / Q000187:drug effects*; D012720:Severity of Illness Index; D013280:Stomatitis / Q000139:chemically induced / Q000473:pathology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D002860:Chromium Radioisotopes; D005973:Glutamine; D004492:Edetic Acid; D002955:Leucovorin; D005472:Fluorouracil