From the Research
To treat malignant bowel obstruction, the combination of dexamethasone, octreotide, and metoclopramide, also known as "triple therapy," is a viable option, as it has shown a non-significant trend towards improved de-obstruction rates compared to no drug therapy, although further investigation is warranted 1. When considering treatment options for malignant bowel obstruction, it's essential to prioritize the patient's quality of life, morbidity, and mortality.
- The study published in 2021 in The American journal of hospice & palliative care found that the "triple therapy" combination had a non-significant trend towards improved de-obstruction rates, with 95% of patients achieving de-obstruction compared to 83% in the no drug therapy group, although the difference was not statistically significant 1.
- Another study published in 2011 in Supportive care in cancer found that a combination of octreotide, metoclopramide, morphine, and dexamethasone allowed for effective and safe treatment of malignant bowel obstruction at home, with all patients experiencing prompt control of gastrointestinal symptoms and recovery of bowel movements within 1-5 days 2.
- However, it's crucial to note that the evidence is not yet conclusive, and further studies are needed to fully understand the efficacy of these treatment options.
- In terms of medication, metoclopramide has been studied as a potential treatment for pseudo-obstruction of the bowel, but a 1977 study published in The American journal of digestive diseases found it to be ineffective in a double-blind therapeutic trial 3.
- Additionally, a 2003 review published in The American journal of gastroenterology discussed the surgical therapy options for gastroparesis, including gastrostomy, jejunostomy, gastric pacing/stimulation, and gastrectomy, but noted that the benefits of these therapies are not well studied and that a cautious approach is warranted 4.
- A 1981 review published in American journal of hospital pharmacy discussed the pharmacology and therapeutic uses of metoclopramide, highlighting its potential in stimulating the mobility of the upper gastrointestinal tract without increasing gastric secretions, but also noting the need for further studies to assess its value in treating vomiting secondary to anesthesia and chemotherapy 5.