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      Manejo farmacológico de la obstrucción intestinal maligna Translated title: Pharmacological management of malignant bowel obstruction

      case-report

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          Abstract

          Resumen La obstrucción intestinal maligna (OIM) es uno de los problemas más difíciles de manejar por las unidades de cuidados paliativos debido a la elevada carga de síntomas, a menudo recurrentes y, a veces, refractarios entre los pacientes con cáncer avanzado. La falta de estudios contundentes hace que la OIM se maneje empíricamente, existiendo una elevada variabilidad clínica y falta de consenso. Presentamos el caso clínico de un paciente ingresado a cargo de la Unidad de Hospitalización a Domicilio de San Juan de Alicante que presentaba un cuadro de oclusión de intestino delgado debido a implante mesentérico en cuadrante inferior derecho. Se realizó una combinación de agentes propulsores y antisecretivos que actuaron sinérgicamente reduciendo los síntomas gastrointestinales, y presentando una mejoría tanto en la calidad de vida como en el tiempo medio de supervivencia.

          Translated abstract

          Abstract Malignant bowel obstruction (MBI) is one of the most difficult problems to manage by palliative care units because of the high burden of often recurrent and sometimes refractory symptoms among patients with advanced cancer. The lack of robust studies means that MBI is managed empirically, with high clinical variability and lack of consensus. We present the clinical case of a patient in charge of the Home Hospitalization Unit who presented a picture of small bowel occlusion due to mesenteric implant in the lower right quadrant. A combination of propellant and antisecretory agents were used, which acted synergistically to reduce gastrointestinal symptoms, and showed an improvement in both quality of life and average survival time.

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          Most cited references9

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          Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution

          Malignant bowel obstruction (MBO) is a frequent complication in advanced cancer patients, especially in those with abdominal tumors. Clinical management of MBO requires a specific and individualized approach that is based on disease prognosis and the objectives of care. The global prevalence of MBO is estimated to be 3% to 15% of cancer patients. Surgery should always be considered for patients in the initial stages of the disease with a preserved general status and a single level of occlusion. Less invasive approaches such as duodenal or colonic stenting should be considered when surgery is contraindicated in obstructions at the single level. The priority of care for inoperable and consolidated MBO is to control symptoms and promote the maximum level of comfort possible. The spontaneous resolution of an inoperable obstructive process is observed in more than one third of patients. The mean survival is of no longer than 4–5 weeks in patients with consolidated MBO. Polymodal medical treatment based on a combination of glucocorticoids, strong opioids, antiemetics, and antisecretory drugs achieves very high symptomatic control. This review focuses on the epidemiological aspects, diagnosis, surgical criteria, medical management, and factors influencing the spontaneous resolution of MBO in advanced cancer patients.
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            Report of the Clinical Protocol Committee: Development of Randomized Trials for Malignant Bowel Obstruction

            Malignant bowel obstruction (MBO) is a commonly encountered palliative care problem. There have been very few comparative trials in this area, and consequently there is very little clinical evidence upon which therapy can be rationally based. The purpose of this paper is to highlight the discussion and decision-making process that was undertaken by the Clinical Protocol Subcommittee during the development of a proposed clinical trial of best medical care versus surgical or endoscopic treatment for MBO. The development of the proposed clinical trials followed an orderly process. The first step taken was a discussion of a specific definition for MBO. Once agreed upon, this definition helped identify inclusion and exclusion criteria for the proposed trial. This was followed by an extensive literature review, which helped define both surgical and endoscopic approaches to MBO as well as what constituted best medical care. An extensive discussion was then undertaken concerning the best outcome measure of success for medical, surgical, and endoscopic interventions. All of the above steps culminated in two proposed protocols, one for MBO of the small intestine distal to the ligament of Treitz and a second for colonic obstructions. The small intestinal trial is designed to compare surgical intervention versus best medical care, whereas the colonic trial seeks to compare surgery with endoscopically-placed intraluminal stents coupled with best medical care.
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              Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review.

              The use of symptomatic agents has greatly improved the medical treatment of advanced cancer patients with inoperable bowel obstruction. A systematic review of studies of the most popular drugs used in the medical management of inoperable malignant bowel obstruction was performed to assess the effectiveness of these treatments and provide some lines of evidence. Randomized trials that involved patients with a clinical diagnosis of intestinal obstruction due to advanced cancer treated with these drugs were reviewed. Five reports fulfilled inclusion criteria. Three studies compared octreotide (OC) and hyoscine butylbromide (HB), and two studies compared corticosteroids (CSs) and placebo. Globally, 52 patients received OC, 51 patients received HB, 37 patients received CSs, 15 patients received placebo, and 37 patients received both placebo and CSs. On the basis of these few data, the superiority of OC over HB in relieving gastrointestinal symptoms was evidenced in a total of 103 patients. The latter studies had samples more defined in terms of stage and inoperability, and had a shorter survival in comparison with studies of CSs (less than 61 days, most of them less than 20 days). Data on CSs are less convincing, due to the methodological weakness of existing studies. This review confirms the difficulties in conducting randomized controlled trials in this population.
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                Author and article information

                Journal
                had
                Hospital a Domicilio
                Hosp. domic.
                Centro Internacional Virtual de Investigación en Nutrición (CIVIN) (Alicante, Alicante, Spain )
                2530-5115
                June 2020
                : 4
                : 2
                : 81-87
                Affiliations
                [1] orgnameHospital Universitario de San Juan de Alicante orgdiv1Unidad de Hospitalización a Domicilio España
                Article
                S2530-51152020000200004 S2530-5115(20)00400200004
                10.22585/hospdomic.v4i2.102
                b31c57f3-414c-49cd-af49-35c82ded5dc4

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 16 March 2020
                : 03 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 7
                Product

                SciELO Spain

                Categories
                Notas clínicas

                Drug Therapy,Tratamiento Farmacológico,Palliative Care,Intestinal Obstruction,Obstrucción Intestinal,Abdominal Neoplasms,Neoplasias Abdominales,Cuidados Paliativos

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