Glutamine prevents diarrhea in colorectal cancer patients undergoing chemotherapy or chemoradiotherapy: a...

To assess the efficacy of glutamine in preventing diarrhea associated with chemotherapy or chemoradiotherapy in colorectal cancer.

Randomized controlled trials of glutamine in the prevention of chemotherapy-associated diarrhea of colorectal cancer were retrieved from the Cochrane Library, Pubmed, EMBASE, CNKI, and Wanfang by computer up to August 1, 2024. Results were presented using relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI). Publications were reviewed in accordance with the Cochrane Handbook and the guidelines of the Preferred Reporting Project for Systematic Review and Meta-Analysis (PRISMA2020). This study has been registered with INPLASY (registration number: INPLASY202490057).

A total of 5 studies were included, and the total number of patients was 311. Meta-analysis showed that compared with the control group, glutamine supplementation significantly reduced the incidence of chemoradiation-induced diarrhea in colorectal cancer patients (RR = 0.72, 95%CI: 0.60-0.87, P < 0.01, I²=37%). Subgroup analysis found that glutamine was more effective in reducing diarrhea in patients receiving chemotherapy alone than in those undergoing chemoradiotherapy (RR = 0.65, 95%CI: 0.43-0.98, P < 0.05, I²=35%). By tumor location, glutamine reduced diarrhea in the colorectal cancer subgroup (RR = 0.65, 95%CI: 0.44-0.97, P < 0.05, I²=30%) but not in the rectal cancer subgroup (P > 0.05). D-xylose levels were significantly higher in the glutamine group (MD = 0.32, 95%CI: 0.14-0.51, P < 0.01, I²=0%), while C-reactive protein levels were significantly lower (MD = 0.52, 95%CI: 0.32-0.72, P < 0.01, I²=0%). The certainty of evidence for diarrhea was rated as low.

Glutamine supplementation is associated with a reduced incidence of diarrhea in patients with colorectal cancer, with a more pronounced efficacy observed in those receiving chemotherapy alone.