Nutritional support in patients with GVHD of the digestive tract: state of the art

BS Van der Meij, P De Graaf, NJ Wierdsma… - Bone marrow …, 2013 - nature.com
BS Van der Meij, P De Graaf, NJ Wierdsma, JAE Langius, J Janssen, PAM van Leeuwen…
Bone marrow transplantation, 2013nature.com
An important complication of allo-SCT is GVHD, which commonly affects the skin, liver and
digestive tract. Clinical symptoms of GVHD of the digestive tract (GVHD-DT) include
excessive diarrhoea, abdominal pain and cramps, nausea and vomiting, gastrointestinal
bleeding, dysphagia, and weight loss. Treatment is complicated and regarding nutritional
support, only a few guidelines are available. Our aim was to critically appraise the literature
on nutritional assessment, nutritional status and nutritional support for patients with GVHD …
Abstract
An important complication of allo-SCT is GVHD, which commonly affects the skin, liver and digestive tract. Clinical symptoms of GVHD of the digestive tract (GVHD-DT) include excessive diarrhoea, abdominal pain and cramps, nausea and vomiting, gastrointestinal bleeding, dysphagia, and weight loss. Treatment is complicated and regarding nutritional support, only a few guidelines are available. Our aim was to critically appraise the literature on nutritional assessment, nutritional status and nutritional support for patients with GVHD-DT. Evidence shows that GVHD-DT is often associated with malnutrition, protein losing enteropathy, magnesium derangements, and deficiencies of zinc, vitamin B 12 and vitamin D. Limited evidence exists on derangements of magnesium, resting energy expenditure, bone mineral density and pancreatic function, and some beneficial effects of n-3 polyunsaturated fatty acids and pancreatic enzyme replacement therapy. Expert opinions recommend adequate amounts of energy, at least 1.5 g protein/kg body weight, supplied by total parenteral nutrition in cases of severe diarrhoea. When diarrhoea is< 500 mL a day, a stepwise oral upgrade diet can be followed. No studies exist on probiotics, prebiotics, dietary fibre and immunonutrition in GVHD-DT patients. Future research should focus on absorption capacity, vitamin and mineral status, and nutritional support strategies.
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