Role of Octreotide, Scopolamine Butylbromide, and Hydration in Symptom Control of Patients with Inoperable Bowel Obstruction and Nasogastric Tubes

Abstract

Bowel obstruction may be an inoperable complication in patients with end-stage cancer. Scopolamine butylbromide (SB) and octreotide (OCT) have been successfully used with the aim of reducing gastrointestinal (GI) secretions to avoid placement of a nasogastric tube (NGT); however, there have been no comparative studies concerning the efficacy of these drugs. Furthermore, there is little information about the role played by parenteral hydration in symptom control of these patients. In a prospective trial that involved all 17 inoperable bowel-obstructed patients presenting to our services with a decompressive NGT, patients were randomized to OCT 0.3 mg/day or SB 60 mg/day for 3 days through a continuous subcutaneous infusion. Clinical data, survival time, and the time interval from the first diagnosis of cancer to the onset of inoperable bowel obstruction were noted. The intensity of pain, nausea, dry mouth, thirst, dyspnea, feeling of abdominal distension, and drowsiness were assessed by means of a verbal scale before starting treatment with the drugs under study (T0) and then daily for 3 days (T1, T2, T3). Moreover, daily information was collected regarding the quantity of GI secretions through the NGT, the oral intake of fluids, the quantity of parenteral hydration, and the analgesic therapy used. The NGT could be removed in all 10 home care and in 3 hospitalized patients without changing the dosage of the drugs. OCT significantly reduced the amount of GI secretions at T2 (P = 0.016) and T3 (P = 0.020). Compared to the home care patients, the hospitalized patients received significantly more parenteral hydration (P = 0.0005) and drank more fluids (P = 0.025). There was no difference in the daily thirst and dry mouth intensity in relation to the amount of parenteral hydration or the treatment provided (OCT or SB). Independent of antisecretory treatment, the patients receiving less parenteral hydration presented significantly more nausea (T0 P = 0.002; T1 P = 0.001; T2 P = 0.003; T3 P = 0.001) and drowsiness at T3 (P < 0.5). Pain relief was obtained in all 17 patients and only two patients required an increase in morphine dose at T1. All patients with inoperable malignant bowel obstruction should undergo treatment with antisecretory drugs so as to evaluate the possibility of removing the NGT. When a more rapid reduction in GI secretions is desired, OCT should be considered as the first choice drug. Parenteral hydration over 500 ml/day may reduce nausea and drowsiness.

Clinical Impact of Palliative Treatment Using Octreotide for Inoperable Malignant Bowel Obstruction Caused by Advanced Urological Cancer

“…Rapid relief of symptoms was achieved in most patients within 1-5 days, more commonly within 2 days. Overall response rate was satisfactory compared with previous reports (Khoo et al, 1994;Ripamonti et al, 2000;Mystakidou et al, 2002;Hisanaga et al, 2010). The results indicated that octreotide was effective in managing MBO symptoms in urological cancer.…”

Sequential Expression of the Neuropeptides Substance P and Somatostatin in Granulomas Associated with Murine Cysticercosis

“…Somatostatin, another neuropeptide, counteracts the effects of SP and mediates analgesic effects by inhibiting the pain induced by noxious agents (15,16,25,28,30). Macrophages, after stimulation by IFN-␥ and TNF-␣, produce large amounts of somatostatin, while lymphocytes express somatostatin re-ceptors (4,9,10,39).…”

Updates in palliative care – recent advancements in the pharmacological management of symptoms

“…Parenteral fluids should be considered and may even help reduce nausea and drowsiness. 26 In patients who have no colic, a prokinetic (eg metoclopramide) is recommended, to help relieve a partial or functional obstruction. 8 If this causes colic or is not effective despite therapeutic dose, it should be stopped.…”