Obstipation in der Palliativmedizin

Abstract

Palliative patients are at risk for the emergence of constipation, impairing their quality of life. Agents with constipating properties, such as opioids, neuroleptics, and serotonin antagonists, are causes for constipation, beside immobility, a poor general condition, insufficient nutrition, or insufficient intake of liquids. Different pathophysiological mechanisms lead to constipation. Its assessment and diagnosis should refer to the Rome-III criteria, taking into account a stool free interval of more than 72 hours, the assessment of the subjective „feeling of being constipated”, and the consistence of the stool. The use of laxatives should adapt to these pathophysiological causes according to a step scheme, both for prophylaxis and therapy. The combinational use of osmotic and stimulant laxatives is most effective. Recent approaches include opioid antagonists for the management of an opioid-induced constipation.

Literatur

• 1 Thomas J. Cancer-related constipation.  Curr Oncol Rep. 2007;  9 (4) 278-284
• 2 Stewart W F, Libermann J N, Sandler R S. et al . Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features.  Am J Gastroenterol. 1999;  94 (12) 3530-3540
• 3 Sykes N P. Constipation and diarrhoea. In: Oxford Textbook of Palliative Medicine. Oxford; Oxford University Press 1998: 513-526
• 4 Twycross R G, Lack S A. Constipation. In: Control of Alimentary Symptoms in Far Advanced Cancer. London; Churchill Livingstone 1986: 166-207
• 5 Drossman D A. The functional gastrointestinal disorders and the Rome III process.  Gastroenterology. 2006;  130 (5) 1377-1390
• 6 Baines M J. The pathophysiology and management of malignant intestinal obstruction. In: Oxford Textbook of Palliative Medicine. Oxford; Oxford University Press 1998: 526-534
• 7 Cash B D, Chey W D. Review article: The role of serotonergic agents in the treatment of patients with primary chronic constipation.  Aliment Pharmacol Ther. 2005;  22 1047-1060
• 8 Shook J E, Pelton J T, Hruby V J. et al . Peptide opioid antagonist separates peripheral and central opioid antitransit effects.  J Pharmacol Exp Ther. 1987;  243 492-500
• 9 Maguire L C, Yon J L, Miller E. Prevention of narcotic-induced constipation.  N Engl J Med. 1981;  305 1651
• 10 De Schepper H U, Cremonini F, Park M I. et al . Opioids and the gut: pharmacology and current clinical experience.  Neurogastroenterol Motil. 2004;  16 383-394
• 11 Pappagallo M. Incidence, Prevalence, and Management of Opioid Bowel Dysfunction.  Am J Surg. 2001;  182 (Suppl) 11-18
• 12 Sykes N P. The relationship between opioid use and laxative use in terminally ill cancer patients.  Palliat Med. 1998;  12 375-382
• 13 Wirz S, Wartenberg H C, Nadstawek J. Less nausea, emesis, and constipation comparing hydromorphone and morphine? A prospective open-labeled investigation on cancer pain.  Support Care Cancer. 2007;  20 epub
• 14 Tamayo A C, Diaz-Zuluaga P A. Management of opioid-induced bowel dysfunction in cancer patients.  Support Care Cancer. 2004;  12 613-618
• 15 Wirz S, Klaschik E. Management of constipation in palliative care patients undergoing opioid therapy: Is polyethylene glycol an option?.  Am J Hosp Palliat Care. 2005;  22 (5) 375-381
• 16 Miles C L, Fellowes D, Goodman M L. et al . Laxatives for the management of constipation in palliative care patients.  Cochrane Database of Systematic Reviews. 2006;  ((4))
• 17 Derby S, Portenoy R K. Assessment and management of opioid-induced constipation. In: Portenoy RK, Bruera E (eds) Topics in palliative care 1. New York; Oxford University Press 1998: 95-112
• 18 Klaschik E, Nauck F, Ostgathe C. Constipation modern laxative therapy.  Support Care Cancer. 2003;  11 (11) 679-685
• 19 Choi Y S, Billings J A. Opioid antagonists: a review of their role in palliative care, focusing on use in opioid-related constipation.  J Pain Symptom Manage. 2002;  24 71-90