title: Medical Therapy of Malignant Bowel Obstruction With Octreotide, Dexamethasone, and Metoclopramide.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Combination medical therapy may provide rapid improvement in symptoms associated with malignant bowel obstruction and dysfunction.
authors: Divisions of Palliative Medicine and Geriatrics, Winthrop University Hospital, Mineola, NY, USA.
authors: Jeffrey
authors: J
authors: Berger
authors: Divisions of Geriatrics and Palliative Medicine, Winthrop University Hospital, Mineola, NY, USA.
authors: Paula
authors: P
authors: Lester
authors: Division of Palliative Care, Flushing Hospital, Flushing, NY, USA lrodrigues615@gmail.com.
authors: Lucan
authors: L
authors: Rodrigues
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000188:drug therapy* / Q000209:etiology; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010166:Palliative Care; D012189:Retrospective Studies
chemical_list: D005765:Gastrointestinal Agents; D003907:Dexamethasone; D008787:Metoclopramide; D015282:Octreotide
keywords: dexamethasone; malignant bowel dysfunction; malignant bowel obstruction; metoclopramide; octreotide