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Clinical Nutrition

Effect of inulin and fructo-oligosaccharide on the prevention of acute radiation enteritis in patients with gynecological cancer and impact on quality-of-life: a randomized, double-blind, placebo-controlled trial

European Journal of Clinical Nutrition volume 70, pages 170–174 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

The pathogenesis of enteritis after abdominal radiotherapy (RT) is unknown, although changes in fecal microbiota may be involved. Prebiotics stimulate the proliferation of Lactobacillus spp and Bifidobacterium spp, and this may have positive effects on the intestinal mucosa during abdominal RT.

Subjects/Methods:

We performed a randomized, double-blind, placebo-controlled trial involving patients with gynecological cancer who received abdominal RT after surgery. Patients were randomized to receive prebiotics or placebo. The prebiotic group received a mixture of fiber (50 inulin and 50% fructo-oligosaccharide), and the placebo group received 6 g of maltodextrin twice daily from 1 week before to 3 weeks after RT. The number of bowel movements and stool consistency was recorded daily. Diarrhea was evaluated according to the Common Toxicity Criteria of the National Cancer Institute. Stool consistency was assessed using the 7-point Bristol scale. Patients’ quality-of-life was evaluated at baseline and at completion of RT using the EORTC-QLQ-C30 (European Organization for Research and Treatment of Cancer quality-of-life Questionnaire C30) test.

Results:

Thirty-eight women with a mean age of 60.3±11.8 years participated in the study. Both groups (prebiotic (n=20) and placebo (n=18)) were comparable in their baseline characteristics. The number of bowel movements per month increased in both groups during RT. The number of bowel movements per day increased in both groups. The number of days with watery stool (Bristol score 7) was lower in the prebiotic group (3.3±4.4 to 2.2±1.6) than in the placebo group (P=0.08). With respect to quality-of-life, the symptoms with the highest score in the placebo group were insomnia at baseline and diarrhea toward the end of the treatment. In the prebiotic group, insomnia was the symptom with the highest score at both assessments, although the differences were not statistically significant.

Conclusions:

Prebiotics can improve the consistency of stools in gynecologic cancer patients on RT. This finding could have important implications in the quality-of-life of these patients during treatment.

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References

  1. Walsh D . Deep tissue traumatism from roentgen ray exposure. Br Med J 1897; 2: 272–273.

    Article  CAS  Google Scholar 

  2. Shadad AK, Sullivan FJ, Martin JD, Egan LJ . Gastrointestinal radiation injury: prevention and treatment. World J Gastroenterol 2013; 19: 199–208.

    Article  Google Scholar 

  3. Andreyer HJ, Vlavianos P, Blake P, Dearnaley D, Norman AR, Tait D . Gastrointestinal symptoms after pelvic radiotherapy: role for the gastroenterologist. Int J Radiat Oncol Biol Phys 2005; 62: 1464–1471.

    Article  Google Scholar 

  4. Harb AH, Abou C, Sharara A . Radiation enteritis. Curr Gastroenterol Rep 2014; 16: 383–394.

    Article  Google Scholar 

  5. Yarnold J, Brotons MC . Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol J Eur Soc Ther Radiol Oncol 2010; 97: 149–161.

    Article  CAS  Google Scholar 

  6. Khalid U, Norman AR, Andreyev HJ . Elevated C-reactive protein levels are not a feature of uncomplicated radiation – induced bowel injury. Eur J Cancer Care 2007; 16: 346–350.

    Article  CAS  Google Scholar 

  7. Hile A, Schmidt-Giese E, Hermann RM, Herrmann MK, Rave-Fränk M, Schirmer M et al. A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment. Scand J Gastroenterol 2008; 43: 52–58.

    Article  Google Scholar 

  8. Lutgens L, Lambin O . Biomarkers for radiation-induced small bowel epithelial damage an emerging role for plasma Citruline. World J Gastroenterol 2007; 13: 3033–3042.

    Article  CAS  Google Scholar 

  9. Sidhu R, Sanders DS, Morris AJ, McAlindon ME . Guidelines on study of small bowel endoscopy and capsule endoscopy in adults. Gut 2008; 57: 125–136.

    Article  CAS  Google Scholar 

  10. Henson CC, Burden S, Davidson SE, Lal S . Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy (Review). Cochrane Database Syst Rev 2013; 11: CD009896.

    Google Scholar 

  11. Wedlake LJ, Shaw C, Whelan K, Andreyev HJ . Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther 2013; 37: 1046–1105.

    Article  CAS  Google Scholar 

  12. Vidal-Casariego A, Calleja-Fernandez A, Ortiz Urbina-Gonzalez JJ, Cano-Rodríguez I, Cordido F, Ballesteros-Pomar MD . Efficacy of glutamine in the prevention of acute radiation enteritis: a randomized controlled trial. J Parenter Enteral Nutr 2014; 38: 205–213.

    Article  Google Scholar 

  13. Delia P, Sansotta G, Donato V, Messina G, Frosina P, Pergolizzi S et al. Prevention of radiation-induced diarrhea with the use of VSL#3 a new high-potency probiotic preparation. Am J Gastroenterol 2002; 97: 2150–2152.

    Article  Google Scholar 

  14. Delia P, Sansotta G, Donato V, Frosina P, Messina G, De Renzis C et al. Use of probiotics for prevention of radiation-induced diarrhea. World J Gastroenterol 2007; 15: 912–915.

    Article  Google Scholar 

  15. Urbancsek H, Kasar T, Mezen I, Neumann K . Results of a double-blind randomized study to evaluate the efficacy and safety of Antibiophilus in patients with radiation-induced diarrhea. Eur J Gastroenterol Hepatol 2001; 13: 391–396.

    Article  CAS  Google Scholar 

  16. Chitapanarux I, Chitapanarux T, Traisathit P, Kudumpee S, Tharavichitkul E, Lorvidhaya V . Randomized controlled trial of live lactobacillus acidophilus plus bifidobacterium bifidum in prophylaxis of diarrhea during radiotherapy in cervical cancer patients. Radiat Oncol 2010; 5: 1–6.

    Article  Google Scholar 

  17. Salminen E, Elomaa I, Minkkimen J, Vapaatalo H, Salminen S . Preservation of intestinal integrity during radiotherapy using live lactobacillus acidophilus cultures. Clin Radiol 1988; 39: 435–437.

    Article  CAS  Google Scholar 

  18. Timko J . Probiotic as prevention of radiation-induced diarrhea. J Radiother Pract 1010; 9: 201–208.

    Article  Google Scholar 

  19. Osterlund P, Ruotsalainen T, Korpela R, Saxelin M, Ollus A, Valta P et al. Lactobacillus supplementation for diarrhea related to chemotherapy of colorectal cancer: a randomized study. Br J Cancer 2007; 97: 1028–1034.

    Article  CAS  Google Scholar 

  20. Giralt J, Perez J, Verges R, Romero J, de la Fuente I, Biete A et al. Effects of probiotic Lactobacillus casei DN-114 in prevention of radiation-induced diarrhea: results from multicenter, randomized, placebo-controlled nutritional trial. Int J Radiat Oncol Biol Phys 2008; 71: 1213–1219.

    Article  Google Scholar 

  21. Gibson RJ, Keefe DM, Laila RV, Bateman E, Blijlevens N, Fijlstra M et al. Systematic review of agents for the management of gastrointestinal mucositis in cancer patients. Support Care Cancer 2013; 21: 313–326.

    Article  Google Scholar 

  22. Hamad A, Fragkos KC, Forbes A . A systematic review and meta-analysis of probiotics for the management of radiation induced bowel disease. Clin Nutr 2013; 32: 353–360.

    Article  Google Scholar 

  23. Demers M, Dagnault A, Desjardins J . A randomized double-blind controlled trial: impact of probiotics on diarrhea in patients treated with pelvic radiation. Clin Nutr 2014; 33: 761–767.

    Article  Google Scholar 

  24. Garcia –Peris P, Velasco C, Lozano MA, Moreno Y, Paron L, de la Cuerda C et al. Effect of a mixture of inulin and fructo-oligosaccharide on Lactobacillus and Bifidobacterium intestinal microbiota of patients receiving radiotherapy: a randomised, double-blind, placebo-controlled trial. Nutr Hosp 2012; 27: 1908–1915.

    PubMed  Google Scholar 

  25. Douglas J . International commission on radiation units and measurements (Report 50). Med Phys 1994; 21: 833.

    Article  Google Scholar 

  26. U.S. National Institutes of Health. Common Toxicity Criteria, version 20. National Institutes of Health, National Cancer, Institute: Bethesda, MD, USA, 1999. Available at ctep.cancer.gov (accessed 30 April 1999).

  27. O’Donnell LJ, Virjee J, Heaton KW . Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ 1990; 300: 439–440.

    Article  Google Scholar 

  28. Fayers PM, Aaronson NK, Bjordal K EORTC QLQ-C30 scoring manual, 9th edn, EORTC: Brussels, Belgium, 1999..

  29. Hovdenak N, Fajardo LF . Hauer – Jensen M. Acute radiation proctitis: A sequential clinicopathologic study during pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2000; 48: 1111–1117.

    Article  CAS  Google Scholar 

  30. Guarner F, Khan A, Garisch J, Eliakim R, Gangl A, Thomson A et al. World Gastroenterolgy Organization Global Guidelines. Probiotics and Prebiotics. J Clin Gastroenterol 2012; 46: 468–481.

    Article  Google Scholar 

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Acknowledgements

We acknowledge the support of Vegenat SA for the performance of this study.

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Authors and Affiliations

  1. Nutrition Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    P Garcia-Peris, C Velasco, L Paron, C de la Cuerda, I Breton & M Camblor

  2. Department of Biotechnology, Polytechnic University of Valencia, Valencia, Spain

    M Hernandez

  3. Radiotherapy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    M A Lozano

  4. Digestive System Research Unit, Hospital General Vall d' Hebron, Barcelona, Spain

    F Guarner

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  1. P Garcia-Peris
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Correspondence to P Garcia-Peris.

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Garcia-Peris, P., Velasco, C., Hernandez, M. et al. Effect of inulin and fructo-oligosaccharide on the prevention of acute radiation enteritis in patients with gynecological cancer and impact on quality-of-life: a randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr 70, 170–174 (2016). https://doi.org/10.1038/ejcn.2015.192

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