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Mucositis: Causes, Symptoms and Treatment

Mucositis is an inflammation of the mucous membranes, most commonly occurring as a side effect of chemotherapy or radiation therapy. It causes pain, redness, and sores in the mouth or gastrointestinal tract.

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Things worth knowing about "Mucositis"

Mucositis is an inflammation of the mucous membranes, most commonly occurring as a side effect of chemotherapy or radiation therapy. It causes pain, redness, and sores in the mouth or gastrointestinal tract.

What is Mucositis?

Mucositis refers to inflammation of the mucous membranes (mucosa) lining various parts of the body. It most commonly affects the mouth and throat – known as oral mucositis – or the entire gastrointestinal tract, referred to as gastrointestinal mucositis. It is one of the most frequent and debilitating side effects associated with cancer treatment.

Causes

Mucositis develops primarily due to damage to the sensitive cells lining the mucous membranes. The most common triggers include:

Chemotherapy: Certain cytotoxic agents (e.g., methotrexate, 5-fluorouracil) target rapidly dividing cells, including mucosal cells.
Radiation therapy: Particularly when directed at the head and neck region, radiation frequently causes severe oral mucositis.
Stem cell transplantation: High-dose conditioning regimens prior to transplantation significantly increase the risk.
Immunosuppression: A weakened immune system makes the mucosa more vulnerable to inflammation and infection.

Symptoms

Symptoms of mucositis vary depending on the area affected. Common complaints include:

Redness, swelling, and burning of the mucous membranes
Painful sores and ulcers in the mouth (aphthae)
Difficulty swallowing and problems eating or drinking
Dry mouth or excessive saliva production
Nausea, vomiting, and diarrhea (in gastrointestinal mucositis)
Increased risk of infection due to a disrupted mucosal barrier

Severity Grades

The World Health Organization (WHO) classifies oral mucositis into four grades of severity:

Grade 1: Mild redness and swelling, no pain
Grade 2: Painful lesions, but the patient is still able to eat solid food
Grade 3: Liquid diet required due to severe pain
Grade 4: Oral nutrition no longer possible; life-threatening complications may occur

Diagnosis

Mucositis is primarily diagnosed through a thorough clinical examination of the oral mucosa and a detailed patient history. For gastrointestinal mucositis, imaging studies or endoscopy may be required. Standardized assessment tools such as the WHO scale or the NCI-CTCAE scale are used to grade severity.

Treatment

A causal treatment for mucositis is often not possible. The focus is therefore on relieving symptoms and preventing complications:

General Measures

Careful oral hygiene using a soft toothbrush and mild mouth rinses (e.g., saline solution)
Adequate fluid intake
Soft or liquid diet adjusted to the level of pain
Avoidance of alcohol, tobacco, and spicy foods

Pharmacological Treatment

Pain relief: Topical anesthetics (e.g., lidocaine-containing mouth rinses), systemic analgesics for severe pain
Antimicrobial agents: Antifungals or antibiotics may be necessary in cases of secondary infection
Palifermin (keratinocyte growth factor): Approved for the prevention of severe mucositis in selected oncology patients
Low-level laser therapy (photobiomodulation): May help reduce pain and support mucosal healing

Nutritional Support

In cases of severe mucositis, artificial nutrition via a nasogastric tube or parenteral nutrition may be required to ensure adequate nutrient supply.

Prevention

Preventive measures are especially important for cancer patients. These include consistent oral hygiene before and during therapy, cryotherapy (sucking on ice chips during chemotherapy infusion), and early dental evaluation prior to starting cancer treatment.

References

Sonis ST. - Pathobiology of oral mucositis: novel insights and opportunities. Journal of Supportive Oncology, 2007.
World Health Organization (WHO) - Handbook for Reporting Results of Cancer Treatment. WHO Offset Publication No. 48, Geneva, 1979.
Lalla RV et al. - MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. Cancer, 2014.

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