The role of dietary supplements, including biotics, glutamine, polyunsaturated fatty acids and polyphenols, in reducing gastrointestinal side effects in patients undergoing pelvic radiotherapy: A systematic review and meta-analysis,
Objective: Pelvic radiotherapy (RT) often results in toxicity to the gastrointestinal tract and clinical trials have demonstrated a potentially beneficial role of dietary supplements in overcoming this problem, mainly acute effects. This systematic review and meta-analysis were undertaken with the aim of evaluating the efficacy of several dietary supplement interventions in preventing or alleviating symptoms of gastrointestinal toxicity in patients undergoing RT for a range of common pelvic malignancies.
Design: The search protocol was prospectively submitted to PROSPERO at the University of York. CENTRAL, MEDLINE, EMBASE, and ClinicalTrials.gov were searched up to June 2020 for randomised controlled clinical trials. Interventions included four supplement categories: biotics, amino acids, poly-unsaturated fatty acids and polyphenols. Efficacy was determined with reference to outcomes based on symptoms of acute gastrointestinal toxicity, including diarrhoea, nausea and vomiting.
Results: Twenty-three randomised controlled trials (1919 patients) were identified in this review. Compared with placebo, probiotics, synbiotics and polyphenols were significantly associated with a lower risk of diarrhoea. Biotic supplements also reduced the risk of moderate to severe diarrhoea and the need for anti-diarrhoeal medication. In contrast, amino acid supplements had no effect on acute symptoms. There was a non-significant trend for reduction in nausea and mean bowel movements per day using dietary supplements.
Conclusions: Biotic supplements, especially probiotics and synbiotics, reduce acute symptoms of gastrointestinal toxicity in patients undergoing pelvic radiotherapy. More randomised placebo-controlled studies with larger numbers of patients are needed to define specific formulations for supplement interventions that will be of greatest benefit to patients.
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