Protocols for the use of glutamine in oral mucositis in a hospital setting: An integrative review.
DOI:
https://doi.org/10.36557/2674-8169.2026v8n6p14036-1455Keywords:
Glutamine; Stomatitis; Treatment OutcomeAbstract
Oral mucositis is one of the most prevalent and debilitating complications associated with antineoplastic treatment, directly impacting quality of life, therapeutic continuity, and clinical prognosis of hospitalized patients. Glutamine, a conditionally essential amino acid in situations of metabolic stress, has been investigated as a therapeutic and preventive strategy for this condition. The present study aimed to identify, analyze, and systematize protocols described in the scientific literature for the use of glutamine in the management of oral mucositis in the hospital setting. This is an integrative literature review conducted in the PubMed/MEDLINE, LILACS, and SciELO databases, with a temporal range between 2015 and 2025, using the descriptors Stomatitis;, Glutamine, and Mouth Treatment Outcome. Seven studies were selected and analyzed according to thematic categories: route of administration, dosage, protocol duration, hospital application context, and clinical effectiveness. The results showed that glutamine was used via systemic oral, topical, and intravenous routes, with doses ranging from 10g to 30g/day in oral formulations and concentrations from 5% to 10g/liter in topical formulations. Protocols with preventive initiation and oral doses of 30g/day showed more consistent results. The topical route proved effective in oncologic, pediatric, and surgical populations, reducing mucositis severity, pain control, and additionally reducing oral bacterial colonization and the incidence of nosocomial pneumonia. Despite predominantly favorable findings, methodological heterogeneity among studies prevents the definition of a standardized clinical protocol. It is concluded that there is scientific support for the use of glutamine in the prevention and treatment of oral mucositis in the hospital environment, and larger randomized clinical trials are needed for the consolidation of robust clinical guidelines.
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Algara M, Rodríguez N, Viñals P, Lacruz M, Foro P, Reig A, et al. Prevention of radiochemotherapy induced esophagitis with glutamine: results of a pilot study. Int J Radiat Oncol Biol Phys. 2007;69(2):342-9.
Al-Taie A, Koseoglu A. Potential therapeutic effects of different mouthwashes for alleviation and treatment of oral complications of 5-fluorouracil-based chemotherapy in patients with colon cancer. Eur J Hosp Pharm. 2023;30(4):202-7
Anderson PM, Schroeder G, Skubitz KM. Oral glutamine reduces the duration and severity of stomatitis after cytotoxic cancer chemotherapy. Cancer. 1998;83(7):1433-9.
Bockel S, Vallard A, Lévy A, François S, Bourdis M, Le Gallic C, et al. Pharmacological modulation of radiation-induced oral mucosal complications. Cancer Radiother. 2018;22(5):429-37.
Brito LF, Silva LS, Fernandes DD, Pires RA, Nogueira ADR, Souza CL, et al. Perfil nutricional de pacientes com câncer assistidos pela casa de acolhimento ao paciente oncológico do sudoeste da Bahia. Rev Bras Canc. 2012;58(2):163-71.
Campos FG, et al. Importância da glutamina em nutrição na prática clínica. Arq Gastroenterol. 1996;33(2):86-92.
Cerchietti LC, Navigante AH, Lutteral MA, Castro MA, Kirchuk R, Bonomi M, et al. Double-blinded, placebo-controlled trial on intravenous L-alanyl-L-glutamine in the incidence of oral mucositis following chemoradiotherapy in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2006;65(5):1330-7.
Curi R. Glutamina: metabolismo e aplicações clínicas e no esporte. Rio de Janeiro: Sprint; 2000. 261 p.
Decker GM. Glutamine: indicated in cancer care? Clin J Oncol Nurs. 2002;6(2):112-5.
Fernandes LC, Curi R. Glutamina e câncer. In: Curi R. Glutamina: metabolismo e aplicações clínicas e no esporte. Rio de Janeiro: Sprint; 2000. cap. 14.
Gao Y, Yang H, Zhang X, Ma Y, Wang L. Effectiveness of glutamine oral care in reducing oral mucositis and improving oral health after neurosurgery: a randomized controlled trial with microbiome analysis. Med Sci Monit. 2024;30:e942585.
Handschel J, et al. Increase of RM3/1-positive macrophages in radiation-induced oral mucositis. J Pathol. 2001;193(2):242-7.
Hong RW, et al. Glutamine preserves liver glutathione after lethal hepatic injury. Ann Surg. 1992;215:114-9.
Huang CJ, Huang MY, Fang PT, Chen F, Wang YT, Chen CH, et al. Randomized double-blind, placebo-controlled trial evaluating oral glutamine on radiation-induced oral mucositis and dermatitis in head and neck cancer patients. Am J Clin Nutr. 2019;109(3):606-14.
Ikebe T, et al. Severity of oral mucositis correlates with the response of oral cancer to preoperative radiochemotherapy. Int J Oral Maxillofac Surg. 2005;34:642-5.
Izaola O, de Luis DA, Cuellar L, Terroba MC, Ventosa M, Martin T, et al. Influence of an immuno-enhanced formula in postsurgical ambulatory patients with head and neck cancer. Nutr Hosp. 2010;25(5):793-6.
Kankaanranta L, Seppälä T, Koivunoro H, Saarilahti K, Atula T, Collan J, et al. Boron neutron capture therapy in the treatment of locally recurred head-and-neck cancer: final analysis of a phase I/II trial. Int J Radiat Oncol Biol Phys. 2012;82(1):e67-75.
Klimberg VS, McClellan JL. Glutamine, cancer, and its therapy. Am J Surg. 1996;172(5):418-24.
Köstler WJ, Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin. 2001;51(5):290-315.
Lacey JM, Wilmore DW. Is glutamine a conditionally essential amino acid? Nutr Rev. 1990;48(8):297-309.
Massunaga VM, Ayoub AC, Frias MAE, Kobayashi RM. Efeitos colaterais da quimioterapia: complicações no sistema digestivo. In: Ayoub AC, Frias MAE, Barros MA, Kobayashi RM. Bases da enfermagem em quimioterapia. São Paulo: Lemar; 2000. p. 371-84.
Pachón Ibáñez J, Pereira Cunill JL, Osorio Gómez GF, Irles Rocamora JA, Serrano Aguayo P, Quintana Ángel B, et al. Prevention of oral mucositis secondary to antineoplastic treatments in head and neck cancer by supplementation with oral glutamine. Nutr Hosp. 2018;35(2):428-33.
Peterson DE. Research advances in oral mucositis. Curr Opin Oncol. 1999;11(4):1-7.
Porok D, Kristjanson L, Nikoletti S, Cameron F, Pedler P. Predicting the severity of radiation skin reactions in women with breast cancer. Oncol Nurs Forum. 1998;25(6):1019-29.
Sanguineti G, Rao N, Gunn B, Ricchetti F, Fiorino C. Predictors of PEG dependence after IMRT±chemotherapy for oropharyngeal cancer. Radiother Oncol. 2013;107(3):300-4.
Sankaran SS, Dewan P, Malhotra RK, Harit D, Kashyap B, Yadav M, et al. Glutamine mouthwash for preventing methotrexate-induced mucositis in children with acute lymphoblastic leukemia: a randomized cross-over trial. Indian Pediatr. 2025. doi:10.1007/s13312-025-00042-4.
Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004;4(4):277-84.
Sonis ST. A biological approach to mucositis. J Support Oncol. 2004;2(1):21-36.
Scully C, Epstein JB. Oral health for the cancer patient. Oral Oncol Eur J Cancer. 1996;32B:281-92.
Shewchuk LD, Baracos VE, Field CJ. Dietary L-glutamine supplementation reduces the growth of the Morris Hepatoma 7777 in exercise-trained and sedentary rats. J Nutr. 1997;127(1):158-66.
Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66(3):253-62.
Van Der Hulst RR, Van Kreel BK, Von Meyenfeldt MF, Brummer RJ, Arends JW, Deutz NE, et al. Glutamine and the preservation of gut integrity. Lancet. 1993;341(8857):1363-5.
Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2011;(4):CD000978.
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Copyright (c) 2026 Nathália Maria de Sousa Botelho, Paola Fernanda Leal Corazza, Carolinne Nair de Almeida Costa, Elaine Marcílio Santos, Marco Antônio Rocco, Arthur Gomes Alves de Assis, Gustavo da Silva Martins, José Cássio de Almeida Magalhaes, Gabriela Traldi Zaffalon, Reinaldo Oliveira Guedes Junior, Fernando Martins Baeder
This work is licensed under a Creative Commons Attribution 4.0 International License.
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