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

B S van der Meij, P de Graaf, N J Wierdsma, Jacqueline A E Langius, J J W M Janssen, Paul A M van Leeuwen, O J Visser

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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 B12 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.

Original languageEnglish
Pages (from-to)474-82
Number of pages9
JournalBone Marrow Transplantation
Volume48
Issue number4
DOIs
Publication statusPublished - Apr 2013
Externally publishedYes

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van der Meij, B. S., de Graaf, P., Wierdsma, N. J., Langius, J. A. E., Janssen, J. J. W. M., van Leeuwen, P. A. M., & Visser, O. J. (2013). Nutritional support in patients with GVHD of the digestive tract: state of the art. Bone Marrow Transplantation, 48(4), 474-82. https://doi.org/10.1038/bmt.2012.124