title: Pharmacological treatment of bowel obstruction in cancer patients.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Waterford Regional Hospital, Department of Palliative Medicine, Waterford, Ireland. oconnorbren@hotmail.com
authors.forename: Brenda
authors.initials: B
authors.lastname: O'Connor
authors.forename: Brian
authors.initials: B
authors.lastname: Creedon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D005440:Fluid Therapy; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care / Q000379:methods*; D010289:Parenteral Nutrition, Total
chemical_list: D000305:Adrenal Cortex Hormones; D000700:Analgesics; D018680:Cholinergic Antagonists; D005765:Gastrointestinal Agents