Gastro-esophageal reflux, ulcers, and intestinal mucositis
Mucositis is defined as inflammatory and/or ulcerative lesions of the oral and/or gastrointestinal tract. Infectious disease, immune deficiency and medications can be causative. One of the major causes of mucositis is high-dose cancer therapy.
Alimentary tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus.
With gastro-intestinal mucositis damage occurs to the mucosal membrane of the entire gastro-intestinal tract. The patient may experience nausea, passage problems, stomach discomfort, intestinal cramping, bloating, loose stools or decreased urgency with loss of mucus. With radiation therapy to the esophagus or stomach, pain, nausea and dysphagia are common. When the intestines receive radiation therapy, such as with bladder and prostate cancer, colon cancer, uterine and cervical cancer and lymphomas, defecation patterns are disrupted as decreased urgency, and increased defecation frequency of thin watery stools sometimes with bloody mucus and anal pain, can occur.
Large fluid losses with radiation therapy are not usually of concern. Symptoms arise around the second or third week of treatment, and generally disappear a few weeks after treatment completion. Symptoms sometimes remain after the radiation therapy has completed such as decreased urgency, increased frequency, and incontinence. Serious complications such as intestinal obstruction, fistula formation and bleeding may occur in a small percentage of patients due to late radiation toxicity.
With chemotherapy, the entire gastro-intestinal tract may be affected. Assessment of the oral mucosa is an indication to the similar damage to the mucosal membranes of stomach and intestines. Intestinal damage decreases the resorbing ability of the intestines. In the case of severe mucositis (grade 3 and 4) as a result of chemotherapy, possibilities for oral and enteral nutrition are limited therefore often requiring parenteral nutrition. In cancers of the blood, bone marrow and lymph nodes, 90% of the patients treated with stem cell transplantation develop severe forms of oral and gastrointestinal mucositis.