Constipation is common in advanced cancer. Despite this, clinicians' understanding of the underlying changes affecting the colon and the rest of the gastrointestinal tract are limited. Two case histories are used to illustrate the problems encountered when the current approaches to diagnosing and managing altered bowel habits are unsuccessful. An alternative paradigm in which to consider the problems of constipation encountered by some people with advanced cancer is proposed.
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References
1.
EoffJ, LemboA. Optimal treatment of chronic constipation in managed care: Review and roundtable discussion. J Manage Care Pharm, 2008; 14:S3–S17.
2.
Constipation Task Force: An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol, 2005; S1:S1–S22.
3.
RaoS. Constipation: Evaluation and treatment of colonic and anorectal motility disorders. Gastroenterol Clin, 2007; 36:3.
SykesNP. Oxford Textbook of Palliative Medicine, 3rd. Oxford: Oxford University Press, 2004.
6.
de SilvaCMV, ReidR. Gastrointestinal stromal tumors (GIST): C-kit mutations, CD117 expression, differential diagnosis and targeted cancer therapy with Imatinib. Pathology Oncol Res, 2003; 9:13–19.
7.
GayerCP, BassonMD. The effect of mechanical forces on intestinal physiology and pathology. Cell Signal, 2009; 21:1237–1244.
8.
KashyapP, FarrugiaG. Enteric autoantibodies and gut motility disorders. Gastroenterol Clin, 2008; 37:397–410vi–vii.
9.
ThompsonWM, KilaniRK, SmithBB, ThomasJ, JaffeTA, DelongDM, PaulsonEK. Accuracy of abdominal radiography in acute small-bowel obstruction: Does reviewer experience matter?AJR Am J Roentgenol, 2007; 188:W233–W238.
10.
Remes-TrocheJM, RaoSS. Diagnostic testing in patients with chronic constipation. Curr Gastroenterol Rep, 2007; 8:416–424.
11.
CowlamS, VinayagamR, KhanU, MarsdenS, MintyI, MoncurP, BainI, YiannakouYJ. Blinded comparison of faecal loading on plain radiography versus radio-opaque marker transit studies in the assessment of constipation. Clin Radiol, 2008; 63:1326–1331.
12.
BrueraE, VelascoA, BertolinoM, MacDonaldS, HansonJ. The assessment of constipation in terminal cancer patients admitted to a palliative care unit: A retrospective review. J Pain Symptom Manage, 1994; 9:515–519.
Microlax [product information]New South Wales, Australia: Johnson & Johnson Pacific Pty Limited, 2003.
18.
MilesC, FellowesD, GoodmanM, WilkinsonS. Laxatives for the management of constipation in palliative care patients. Cochrane Database Syst Rev, 2006; Oct 18;,4:CD003448.
WaldA. Severe constipation. Clin Gastroenterol Hepatol, 2005; 3:432–435.
21.
van der SpoelJ, Oudemans-van StraatenH, KuiperM, van RoonE, ZandstraD, van der VoortP. Laxation of critically ill patients with lactulose or polyethylene glycol: A two-center randomized, double-blind, placebo-controlled trial. Crit Care Med, 2007; 35:2726–2731.
22.
RadhakrishnanRS, XueH, WeisbrodtN, MooreFA, AllenSJ, LaineGA, CoxCS:Jr. Resuscitation-induced intestinal edema decreases the stiffness and residual stress of the intestine. Shock, 2005; 24:165–170.
