Pharmacological treatment of bowel obstruction in cancer patients.
Affiliation
Waterford Regional Hospital, Department of Palliative Medicine, Waterford,, Ireland. oconnorbren@hotmail.comIssue Date
2012-02-01T10:52:24ZMeSH
Adrenal Cortex Hormones/administration & dosage/therapeutic useAnalgesics/administration & dosage/therapeutic use
Cholinergic Antagonists/administration & dosage/therapeutic use
Fluid Therapy
Gastrointestinal Agents/administration & dosage/therapeutic use
Humans
Intestinal Obstruction/diagnosis/drug therapy/surgery/*therapy
Neoplasms/*complications
Palliative Care/*methods
Parenteral Nutrition, Total
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Expert Opin Pharmacother. 2011 Oct;12(14):2205-14. Epub 2011 Jun 30.Journal
Expert opinion on pharmacotherapyDOI
10.1517/14656566.2011.597382PubMed ID
21714777Abstract
INTRODUCTION: Malignant bowel obstruction (MBO) is a common complication of advanced cancer, occurring most frequently in gynaecological and colorectal cancer. Its management remains complex and variable. This is in part due to the lack of evidence-based guidelines for the clinicians involved. Although surgery should be considered the primary treatment, this may not be feasible in patients with a poor performance status or advanced disease. Advances have been made in the medical management of MBO which can lead to a considerable improvement in symptom management and overall quality of life. AREAS COVERED: This review emphasizes the importance of a prompt diagnosis of MBO with early introduction of pharmacological agents to optimize symptom control. The authors summarize the treatment options available for bowel obstruction in those patients for whom surgical intervention is not a feasible option. The authors also explore the complexities involved in the introduction of parenteral hydration and total parenteral nutrition in this group of patients. EXPERT OPINION: It is not always easy to distinguish reversible from irreversible bowel obstruction. Early and aggressive management with the introduction of pharmacological agents including corticosteroids, octreotide and anti-cholinergic agents have the potential to maintain bowel patency, and allow for more rapid recovery of bowel transit. A combination of analgesics, anti-emetics and anti-cholinergics with or without anti-secretory agents can successfully improve symptom control in patients with irreversible bowel obstruction.Language
engISSN
1744-7666 (Electronic)1465-6566 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1517/14656566.2011.597382
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