Mucositis and non-invasive markers of small intestinal function

Abstract

Mucositis is a common and debilitating side effect of chemotherapy that manifests due to the

inability of chemotherapy agents to discriminate between normal and neoplastic cells. This

results in ulcerating lesions lining the gastrointestinal tract. Moreover, the development of

efficacious treatments for small intestinal mucositis has been hindered as the pathobiology of

mucositis is still not fully understood. The small intestine is an extensive organ which is

largely inaccessible by conventional means. Non-invasive biomarkers such as small intestinal

permeability, H2 breath tests, serum citrulline tests and the 13C-sucrose breath test (SBT) have

emerged as potential markers of small intestinal function. The SBT is emerging as the more

appropriate biomarker to assess chemotherapy-induced mucositis in cancer patients and

animal models, where it measures the decrease in sucrase activity associated with villus

blunting and crypt disruption. The SBT has been successfully applied to detect mucositis

induced by different classes of chemotherapy agents and has been used successfully to

monitor small intestinal function with a range of candidate anti-mucositis treatments. We

propose the SBT a superior biomarker of small intestinal function that could be successfully

applied in clinical practice for monitoring the development of mucositis in cancer patients

undergoing chemotherapy.