Effect of glutamine on oral mucositis in patients undergoing chemotherapy-radiotherapy: A Randomized Clinical Trial

Background: In most malignant diseases, chemotherapy drugs are used as a main complementary method of treatment and have different side effects, which should not be overlooked if we are to provide complete treatment for the patient. These complications include inflammation and oral wounds, referred to as mucositis. This study aimed to investigate the effect of glutamine on oral mucositis in patients undergoing chemotherapy-radiotherapy. Methods:The present conducted on 40 patients with head and neck tumors undergoing chemotherapy or radiotherapy. Each patient was placed in a group that received either the drug (glutamine) or placebo (maltodextrin) based on a random even or odd number that the patient drew from a box. Before the beginning of chemotherapy, the mouth was examined by a trained last-year student, and all patients received oral health education on subjects including brushing and flossing. All patients (medication and placebo) took 10 g of powder. Oral examination of patients was performed in the beginning (day zero) and on the first, fourth, sixth, and tenth days. Mucositis was evaluated according to the Radiation Therapy Oncology Group (RTOG) criteria (zero = no erythema, 1 = light red or pink erythema, 2 = non-dark red, and 3 = dark red). Also, the level of pain and burning in the mouth and throat were measured on all days of the study using the visual analogue scale (VAS). All obtained data were coded and analyzed by SPSS 24. Results: The present study was conducted on 39 patients who were undergoing chemotherapy (female = 17 and male = 22). On days three, seven, and ten of the study, only two subjects in the glutamine group were RTOG grade 1, and the rest of the group were grade 0. In the placebo group, only 2 subjects were grade 1 and the rest were grades 2 and 3. The mean duration of wound healing in the drug treatment group was 4.5 +/- 0.5 days, and its range was 3-9 days. Conclusion: Results showed that glutamine reduced pain and burning and the number of wounds. It also affected patients' outcomes according to the RTOG criteria and improved patients' symptoms