Chemotherapy Related Oral and Gastrointestinal Mucositis

Abstract

Mucositis is the one of the most common complications during chemotherapy or radiotherapy. Once developed, mucositis influences the treatment outcome by severe pain, malnutrition, risk of infection, and prolonged hospitalization. Mucositis is usually developed in oral cavity and gastrointestinal tract. It is developed by the complex pathway, which is composed of initiation by reactive oxygen species, upregulation of various cytokine (e.g. TNF-alpha, IL-1 beta, IL-6), and amplification of tissue injury, ulceration, and healing. Risk factors of mucositis include specific kinds of chemotherapy drug, hematopoietic stem cell transplantation, the site and dose of radiation, concurrent chemoradiation, malnutrition, salivary grand dysfunction, and poor oral hygiene. Routine oral care is very important for the prevention and treatment of oral mucositis and its administration should be included in patient education. Local anesthetics and systemic opioid can be used for severe pain of oral mucositis. Cryotherapy and low-level laser treatment is also useful for prevention of oral mucositis. Diarrhea, which is the most common symptom of gastrointestinal mucositis, can be controlled by loperamide or octreotide. More effective agents or procedures are needed for the prevention and treatment of chemotherapy related oral and gastrointestinal mucositis. The prevention is the most important approach in mucositis care and I therefore multidisciplinary team approach including oncologists, dentists, nurses, and nutritionists is essential.