Medical Therapy of Malignant Bowel Obstruction With Octreotide, Dexamethasone, and Metoclopramide

Am J Hosp Palliat Care. 2016 May;33(4):407-10. doi: 10.1177/1049909115569047. Epub 2015 Feb 2.

Abstract

Background: Malignant bowel obstruction is a highly symptomatic, often recurrent, and sometimes refractory condition in patients with intra-abdominal tumor burden. Gastro-intestinal symptoms and function may improve with anti-inflammatory, anti-secretory, and prokinetic/anti-nausea combination medical therapy.

Objective: To describe the effect of octreotide, metoclopramide, and dexamethasone in combination on symptom burden and bowel function in patients with malignant bowel obstruction and dysfunction.

Design: A retrospective case series of patients with malignant bowel obstruction (MBO) and malignant bowel dysfunction (MBD) treated by a palliative care consultation service with octreotide, metoclopramide, and dexamethasone. Outcomes measures were nausea, pain, and time to resumption of oral intake.

Results: 12 cases with MBO, 11 had moderate/severe nausea on presentation. 100% of these had improvement in nausea by treatment day #1. 100% of patients with moderate/severe pain improved to tolerable level by treatment day #1. The median time to resumption of oral intake was 2 days (range 1-6 days) in the 8 cases with evaluable data. Of 7 cases with MBD, 6 had For patients with malignant bowel dysfunction, of those with moderate/severe nausea. 5 of 6 had subjective improvement by day#1. Moderate/severe pain improved to tolerable levels in 5/6 by day #1. Of the 4 cases with evaluable data on resumption of PO intake, time to resume PO ranged from 1-4 days.

Conclusion: Combination medical therapy may provide rapid improvement in symptoms associated with malignant bowel obstruction and dysfunction.

Keywords: dexamethasone; malignant bowel dysfunction; malignant bowel obstruction; metoclopramide; octreotide.

MeSH terms

  • Abdominal Neoplasms / complications
  • Adult
  • Aged
  • Aged, 80 and over
  • Colonic Diseases / drug therapy*
  • Colonic Diseases / etiology
  • Dexamethasone / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Gastrointestinal Agents / administration & dosage
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Intestinal Obstruction / drug therapy*
  • Intestinal Obstruction / etiology
  • Male
  • Metoclopramide / therapeutic use
  • Middle Aged
  • Octreotide / therapeutic use
  • Palliative Care
  • Retrospective Studies

Substances

  • Gastrointestinal Agents
  • Dexamethasone
  • Metoclopramide
  • Octreotide