Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction

Abstract

In advanced cancer patients with inoperable bowel obstruction, the administration of antisecretive and antiemetic drugs has proved to be effective in controlling gastrointestinal symptoms caused by bowel obstruction. However, controlled studies concerning the most effective antisecretive drug are lacking. The aim of this randomized controlled study was to determine whether octreotide or hyoscine butylbromide was the more effective antisecretive drug for use in states of inoperable bowel obstruction. Eighteen patients with inoperable bowel obstruction randomly received octreotide 0.3 mg daily (n = 9) or hyoscine butylbromide (HB) 60 mg daily (n = 9) s.c. The following parameters were measured: episodes of vomiting, nausea, drowsiness, continuous and colicky pain, using a Likert scale corresponding to a numerical value: (none 0, slight 1, moderate 2, severe 3) recorded before starting the treatment (T0) and 24 h (T1), 48 h (T2) and 72 h after (T3), and the mean daily amounts of fluids administered i.v. or s.c. during the period of study. Three patients dropped out of the study because data were incomplete. Octreotide treatment induced a significantly rapid reduction in the number of daily episodes of vomiting and intensity of nausea compared with HB treatment at the different time intervals examined. No relevant changes were found in dry mouth, drowsiness and colicky pain. Lower levels of hydration were associated with nausea regardless of the treatment. At the doses used in this study, octreotide was more effective than HB in controlling gastrointestinal symptoms of bowel obstruction. Further studies are necessary to understand the role of hydration more clearly in such a clinical situation.

Medical Treatment for Inoperable Malignant Bowel Obstruction: A Qualitative Systematic Review

“…9,10 Patients with high level of bowel obstruction were also included. Chlorpromazine 5e25 mg/day and analgesics were allowed in both groups, and no hydration or parenteral nutrition was provided.…”

“…11 In OC and HB studies, patients receiving the study drugs mainly had a short survival, ranging from 4 to 61 days. 9,10 Study medication did not influence survival, which varied from a few days to more than 300 days. 12 In studies of CSs, a longer survival was recorded.…”

“…11 No differences in dry mouth were found between OC and HB groups. 9,10 Discussion Conducting scientifically sound trials in this population is a considerable challenge. The small number of randomized published trials reflects the difficulty of recruiting an adequate number of patients from among terminally ill cancer patients.…”

Predictors of survival in patients with non‐curative stage IV cancer and malignant bowel obstruction

“…MBO occurs in up to 15% of patients admitted to palliative care wards and in 10-28% of patients diagnosed with colorectal cancer and management can be clinically challenging [2] [3]. Survival is generally poor with a reported median survival of 1-3 months, particularly in the setting of carcinomatosis [4][5][6][7][8][9]. However, there is a population of patients with MBO who can benefit from palliative chemotherapy and surgery and have a prolonged survival of more than a year [10] [11].Consequently, clinical decision making and treatment recommendations in patients with MBO is important and is dependent upon the development of accurate predictors of survival [12].…”

Management of intestinal obstruction in malignant disease

“…The amount of gut secretions and therefore volume and frequency of vomit can be reduced by hyoscine butylbromide or octreotide, a somatostatin analogue (Table 3). [15][16][17] Vomiting may become faeculent when small bowel contents become colonised by bacteria after the obstruction has been present for more than a week. This should be distinguished from faecal vomiting which will occur only when there is a gastrocolic fistula.…”