Mucositis describes inflammation and ulceration of the digestive tract lining. It usually affects the mouth and often results from cancer treatments.

When the thin mucous membrane that lines the digestive tract becomes inflamed, it can be painful. This condition, mucositis, can develop anywhere along the digestive tract, but it is common in the mouth. As such, the term mucositis is more synonymous with oral mucositis.

People who undergo cancer treatments, such as chemotherapy or radiation therapy, have a high risk of developing this condition. These treatments use certain drugs or radiation to destroy cancer cells. However, due to the nature of these treatments, both chemo and radiation can cause adverse reactions, such as inflammation and damage to the gastrointestinal tract.

Some people may also refer to mucositis as stomatitis. However, this term refers more generally to inflammation of oral tissues, while mucositis describes inflammation of mucosa resulting from chemotherapeutic agents or ionizing radiation. People can therefore think of stomatitis as a type of mucositis.

During cancer treatment, pain relief and anti-sickness medications can help to reduce symptoms. Mucositis symptoms should resolve a few weeks after finishing cancer treatment.

In this article, we will discuss the symptoms and causes of mucositis, as well as the treatment options.

Mucositis can cause a range of symptoms, many of which affect the mouth. Some common symptoms of oral mucositis may include:

  • dry mouth
  • shiny, swollen, or red gums
  • soft, white patches or pus on the tongue
  • painful sores in the mouth
  • bad breath
  • blood in the mouth
  • pain or a mild burning sensation while eating
  • trouble swallowing or talking

Possible gastrointestinal symptoms may include:

In very severe cases, mucus, pus, or thick saliva can fill the mouth. If this occurs, it can prevent a person from eating.

Cancer treatments are a common cause of mucositis. Whether or not they are targeting cancer, the following treatments frequently cause mucositis:

  • chemotherapy
  • radiation of the head, chest, or neck
  • bone marrow transplants
  • stem cell transplants

The cells in the body’s mucous membranes divide rapidly, similar to cancer cells. Chemotherapy and radiation therapy attack cancer cells and any other rapidly dividing cells, including those of the mucous membranes.

Some evidence suggests that 35–40% of people who receive chemotherapy may develop mucositis to some extent. The risk is much greater for people who also receive cancer treatment for head and neck cancers.

Several factors can also increase the risk of mucositis. They include:

  • being female
  • young age
  • having received cancer treatment
  • experiencing dry mouth before and during cancer treatment
  • being dehydrated
  • having a chronic condition, such as kidney disease or diabetes
  • having poor oral health and hygiene
  • chewing or smoking tobacco
  • drinking alcohol

Mucositis refers to the inflammation and ulceration of the mucous membranes. It can occur anywhere along the digestive tract, from the mouth to the anus. Typically, people can divide it into oral or gastrointestinal mucositis, depending on its presentation.

Some experts may describe mucositis as having 5 phases of injury:

  1. Initiation: Treatment will begin causing cellular damage, but the mucosa will appear normal.
  2. Signaling: Cells begin responding to the damage by activating molecules that promote inflammation and tissue damage.
  3. Amplification: The release of these molecules leads to a positive feedback loop, which increases inflammation and tissue damage.
  4. Ulceration: The damage from these molecules becomes visible in the form of ulceration.
  5. Healing: Once treatment stops, the tissue can begin healing.

Doctors may also use a variety of scales to evaluate the severity of mucositis. These scales include:

  • Radiation Therapy Oncology Group (RTOG) scale
  • World Health Organization (WHO) oral toxicity scale
  • Common Terminology Criteria for Adverse Events scale
  • National Cancer Institute Common Toxicity Criteria (NCI-CTC)
  • Western Consortium for Cancer Nursing Research stomatitis staging system

While these scales vary slightly, they typically align on a grading scale of 1 to 4. Grade 1 may depict mild symptoms such as redness of the mucosa, while grade 4 displays more severe symptoms, which can include life-threatening complications such as bleeding and deep ulceration.

There are several potential complications of mucositis. A person may, for example, lose their appetite for food and drink.

Mucositis can also increase the risk of bacterial, viral, or fungal infection. A particular risk is septicemia, a bacterial infection of the blood. This can occur due to potential damage to the mucosa, making it more susceptible to pathogens, and many cancer treatments affecting the immune system, which is the body’s defense against infections. As a result of this, cancer treatments can also delay recovery from mucositis.

Additionally, receiving treatment for mucositis can delay cancer treatments or cause additional side effects.

If mucositis symptoms make it difficult to eat or drink, nutrient deficiencies can develop. Someone undergoing cancer treatment may already have difficulty eating, so any additional challenges are especially concerning.

Symptoms of mucositis are often clear in the early stages of cancer treatment. A doctor may be able to diagnose mucositis as early as 1–2 weeks after radiation therapy or within 3 days of chemotherapy.

First, the doctor will assess the person’s symptoms and medical history. They will then ask about past or ongoing cancer treatment and examine the affected area. They may, for example, look for sores and swelling in the mouth.

Treatment usually involves targeting any infection while managing symptoms.

To reduce symptoms, including pain, the doctor may recommend:

  • ice chips, popsicles, and other cold foods
  • topical pain relief medications
  • allergy medications
  • lozenges
  • corticosteroids
  • sprays for preventing dry mouth

To treat the infection, the doctor could suggest:

  • brushing the teeth more frequently each day
  • brushing with a soft toothbrush to help prevent bleeding gums
  • using antiseptic mouthwash

It is not always possible to prevent mucositis. However, a person can take some steps to reduce their risk.

Oral hygiene is an important element in the prevention of mucositis. A person’s oral hygiene routine should include:

  • brushing the teeth regularly
  • using a toothpaste that contains fluoride
  • going for frequent dental checkups
  • using dental floss or interdental brushes to clean between the teeth
  • regularly using mouthwash or gargling with a saltwater solution
  • making sure any dental fixtures fit well

Other preventive measures include:

  • avoiding all tobacco products
  • staying hydrated
  • keeping the lips and mouth moist
  • eating a healthy, balanced diet
  • avoiding hot, spicy, or salty foods
  • limiting the intake of hot, fizzy, or alcoholic drinks
  • avoiding hard or crunchy foods
  • lowering sugar intake

Mucositis can cause pain, discomfort, and difficulty eating. This condition is common among people undergoing cancer treatment, such as chemotherapy or radiation therapy.

Anyone with mucositis should see a doctor, who will recommend treatments to relieve pain and help keep the area moist. To reduce the risk of mucositis, people can maintain good oral hygiene and avoid certain foods and drinks, such as those that are hot, spicy, or alcoholic.