Parenteral feeding during methotrexate-induced gastrointestinal mucositis prevents weight loss in the rat

Background & aims: It is unknown what feeding strategy to use to prevent weight loss in patients with chemotherapy-induced gastrointestinal mucositis. When possible, enteral nutrition is preferred to parenteral nutrition because of negative side effects. In a mucositis rat model, we demonstrated disaccharide maldigestion and fat malabsorption but up to normal absorption of glucose and amino acids upon their continuous enteral administration. We now determined the effects of four different (par)enteral feeding strategies during mucositis on body weight and intestinal recovery. Methods: From days 2 to 5 after injection with methotrexate (60mg/kg), rats continued ad libitum enteral feeding with purified diet (AIN-93G, strategy 1), received continuous enteral feeding [force-feeding, normal daily amounts] with glucose and amino acids (Nutriflex^®, strategy 2) or with standard formula (Nutrini^®, strategy 3), or received continuous parenteral feeding with standard formula (NuTRIflex^® Lipid, strategy 4). Saline-treated controls continued ad libitum purified diet. Results: From day 2 on, methotrexate-treated ad libitum-fed rats showed a reduced food intake and body weight (P < 0.05), as seen before. Most continuously enterally-fed rats (88%) were terminated early because of severe abdominal distention. Parenterally-fed rats grew similarly like controls. On day 5, the jejunum of methotrexate-treated ad libitum-fed rats showed hypertrophic crypts and a normal villus length. In contrast, parenterally-fed rats showed no increase in crypt length and a reduced villus length, compared with controls (P < 0.05). Conclusion: Continuous enteral feeding in normal daily amounts during mucositis is poorly tolerated in rats. Parenteral feeding prevents weight loss during mucositis while enteral feeding in limited amounts accelerates intestinal recovery.