Effect of minimal enteral feeding on recovery in a methotrexate-induced gastrointestinal mucositis rat model.
OBJECTIVE
Patients suffering from gastrointestinal mucositis often receive parenteral nutrition as nutritional support. However, the absence of enteral nutrition might not be beneficial for the intestine. We aimed to determine the feasibility of minimal enteral feeding (MEF) administration in a methotrexate (MTX)-induced mucositis rat model and thereby determine the effect of MEF on recovery.


METHODS
Male Wistar rats were attached to swivel systems from day 1 to 5 after 45 mg/kg MTX IV injection. The MTX group continued ad libitum feeding, and the MTX + MEF group continued ad libitum feeding and received from day 1 to 5 continuously MEF. MEF consisted of 20% of their normal caloric intake. We measured body weight, intake, and plasma citrulline. At day 10, the rats were terminated and villus and crypt length were measured.


RESULTS
The administration of MEF caused no increased severity of mucositis phenotype, with comparable caloric intake, body weight, and plasma citrulline during mucositis. The recovery of plasma citrulline levels was not different between both groups. At day 7 and 8, the MTX + MEF group gained significantly more weight (p < 0.05 and p < 0.01, respectively), and at day 8 and 9 the total caloric intake was significantly increased (p < 0.01 and p < 0.05, respectively) compared to the MTX group. At day 10, the rats from the MTX + MEF group showed a significant increase in jejunal villus length compared to the MTX group (p < 0.05).


CONCLUSIONS
This is the first study in which the feasibility of MEF administration during chemotherapy-induced mucositis was determined. This study indicates that MEF administration is feasible during mucositis and suggests that MEF accelerates recovery after MTX-induced mucositis.
Department of Pediatric Oncology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
Nicoline S S
NS
Kuiken
Department of Pediatrics, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.|Department of Pediatrics, Erasmus Medical Center Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Edmond H H M
EH
Rings
Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
Rick
R
Havinga
Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
Albert K
AK
Groen
Department of Pediatric Oncology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. w.j.e.tissing@umcg.nl.
Wim J E
WJ
Tissing
D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D002956:Citrulline / Q000097:blood*; D004195:Disease Models, Animal; D004750:Enteral Nutrition; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D052016:Mucositis / Q000139:chemically induced*; D051381:Rats; D017208:Rats, Wistar
D000964:Antimetabolites, Antineoplastic; D002956:Citrulline; D008727:Methotrexate
Chemotherapy; Citrulline; Gastrointestinal mucositis; Methotrexate; Minimal enteral feeding; Nutrition; Rat