Gut microbiome and intestinal mucositis: A new challenge for researchers

Abstract

Alimentary mucositis is a major complication in the clinical setting and occurs in many patients undergoing cytotoxic chemotherapy. Mucositis causes a range of symptoms throughout the gastrointestinal tract including ulcers in the oral cavity, nausea, vomiting, diarrhea and constipation.1 Frequently these symptoms are severe enough to warrant breaks or reductions in treatment, which may impact upon treatment effectiveness.1 This represents both a significant clinical and economic burden in oncology. The presence of any mucositis during a cycle of chemotherapy significantly increases the risk of dose reduction, the frequency of infections and bleeding, and increases the length and cost of hospitalization. Reductions in treatment lead to reduced survival. Resource utilization for patients during episodes of mucositis is also significantly increased with the need for nutritional adjuncts including fluid replacement, liquid diets and total parenteral nutrition. Due to the association with infection, antibiotic therapy is also more common in patients with mucositis. Combined, this translates to an incremental cost of US$3500 per cycle of standard dose chemotherapy with mucositis (it is much higher for high dose chemotherapy),3,4 and hence a substantive burden on Medicare.