From the Guidelines
Steroids are not recommended as a treatment option for malignant partial bowel obstruction, as the evidence does not support their efficacy in improving symptoms or quality of life. The most recent and highest quality study, 1, found that corticosteroids were not effective in managing malignant bowel obstruction, and instead recommended other treatments such as surgery, stenting, decompression percutaneous gastrostomy tube, nasogastric tube, or octreotide.
Treatment Options
Other treatment options for malignant partial bowel obstruction include:
- Surgery: may be considered in patients with a reversible cause, good performance status, and lack of complicating factors
- Stenting: a minimally invasive procedure that can help relieve obstruction
- Decompression percutaneous gastrostomy tube: can help relieve symptoms of nausea and vomiting
- Nasogastric tube: can help relieve symptoms of nausea and vomiting, but is usually uncomfortable and increases the risk of aspiration
- Octreotide: a medication that can help reduce symptoms of nausea and vomiting
Medication Management
Medications such as opioids, antiemetics, and anticholinergics may be used to manage symptoms of malignant partial bowel obstruction, but corticosteroids are not recommended due to lack of evidence supporting their efficacy. Octreotide, on the other hand, has been shown to be effective in reducing symptoms of nausea and vomiting, and can be considered as part of a comprehensive treatment plan 1.
Quality of Life
The primary goal of treatment for malignant partial bowel obstruction should be to improve quality of life, rather than just relieving symptoms. Treatment plans should be individualized and take into account the patient's overall health, performance status, and preferences. By prioritizing quality of life and using evidence-based treatments, healthcare providers can help patients with malignant partial bowel obstruction manage their symptoms and improve their overall well-being.
From the Research
Steroids in Malignant Partial Bowel Obstruction
- The use of steroids, specifically dexamethasone, in combination with other medications such as octreotide and metoclopramide, has been studied in the management of malignant bowel obstruction (MBO) 2, 3, 4.
- These studies suggest that the combination of dexamethasone, octreotide, and metoclopramide may lead to relief of obstruction and improvement in symptoms associated with the obstruction, including nausea, pain, and resumption of oral intake 2, 3.
- However, one study found no statistically significant difference in rates of de-obstruction between patients who received triple therapy and those who received no drug therapy, although there was a non-significant trend toward improved de-obstruction in the triple therapy group 4.
- The MASCC guideline update recommends the use of octreotide in non-operable MBO, and suggests that olanzapine or metoclopramide may be effective in reducing nausea and vomiting secondary to partial bowel obstructions, but notes that additional studies are needed to clarify benefits 5.
- Overall, the evidence suggests that steroids, as part of a combination medical therapy, may be helpful in managing symptoms associated with malignant partial bowel obstruction, but further research is needed to fully understand their role in this context 2, 3, 4, 5.