Nutrient digestion and absorption during chemotherapy-induced intestinal mucositis in the rat

PhD ceremony: Ms. M. Fijlstra, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertastion: Nutrient digestion and absorption during chemotherapy-induced intestinal mucositis in the rat

Promotor(s): prof. E.H.H.M Rings, prof. H.J. Verkade, prof. E.S.J.M. de Bont

Faculty: Medical Sciences

Intestinal mucositis (damage to the intestinal mucous membrane) is one of the most frequently occurring and debilitating side effects of anti-cancer treatment in children and adults. Mucositis causes reduced food intake, nausea, vomiting, abdominal pain, diarrhea and weight loss, and may lead to reduced survival of cancer patients. Directed nutritional support might improve the survival rate and intestinal recovery of mucositis patients. However, it is unknown how patients with mucositis are optimally fed: enteral feeding (via the intestine; by eating or using a feeding tube) may be inappropriate for reasons of nutrient maldigestion and malabsorption during mucositis, while parenteral feeding (directly via the blood) bypasses potential intestinal malfunction but is quite invasive and carries an increased risk of infection. We determined nutrient digestion and absorption during mucositis in a chemotherapy-induced mucositis rat model. We showed that only simple sugars (glucose) and small proteins (amino acids) could be absorbed normally during mucositis, as the result of their continuous enteral administration. Unfortunately, such a feeding regimen of glucose and amino acids in daily amounts was often poorly tolerated by the rats. However, tolerated amounts of enteral feeding caused accelerated intestinal recovery. Parenteral feeding, in contrast to enteral feeding, was well tolerated and prevented weight loss during mucositis. Our findings in the rat indicate that the optimal feeding strategy during mucositis consists of a combination of parenteral feeding to prevent weight loss, and tolerated amounts of continuous enteral feeding to optimize intestinal recovery from mucositis. Further studies in patients with mucositis are being conducted to define optimal feeding strategies.