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In patients with cancer, constipation is a common complication. However, unlike in the general population, the impact of the symptoms of constipation on the quality of life in cancer patients is often greater. More importantly, in patients who are in the more advanced stages of the disease, constipation may also be suggestive of disease progression.Constipation as a symptom in this population is of significant importance as it may lead to life-threatening complications, i.e. bowel perforation due to fecal impaction. Therefore, in this regard, this problem deserves particular attention, as early recognition and management of complications may prevent further physical deterioration.This review aims to provide an overview of the management of constipation in patients with cancer. A symptom-based criteria definition for chronic constipation and prevalence of the problem in cancer patients provides a brief introduction. For the initial assessment and evaluation of constipation in cancer patients, an algorithm is described. The different possible etiologies of constipation in cancer patients are also discussed. Regarding therapeutic management, guidelines and recommendations for the use of different types of laxatives, stool softeners, suppositories and rectal enemas, prokinetic agents, antidepressant medications, and miscellaneous agents are succinctly discussed. Management of fecal impaction and opioid-induced bowel dysfunction are also described. Lastly, a brief overview of the management of acute colonic pseudo-obstruction and surgical or endoscopic options for large bowel obstruction are described. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cholecystokinin (CCK) is involved in gastrointestinal motor response to meals. The potential role of CCK receptor antagonists in functional gastrointestinal disorders is unclear.AIMS: To evaluate the effects of dexloxiglumide, a CCK-1 receptor antagonist, on gastrointestinal transit (GIT) and symptoms in patients with constipation-predominant IBS (C-IBS); and to explore the influence of CCK-1 receptor polymorphisms on gut transit and the pharmacodynamic response to therapy.METHODS: A total of 36 patients with C-IBS and normal to slow baseline colonic transit (CT) were randomized (double-blind, parallel design) to 7 days of dexloxiglumide 200 mg or placebo t.i.d. Daily bowel habits diaries and weekly relief of IBS symptoms were recorded. At the end of treatment, GIT and CT were measured. Peripheral blood DNA was examined for polymorphisms in genes controlling CCK: four related to CCK-1, one to the CCK gene promoter, and one related to CCK-2. The distributions of allelic variants and association with gastric emptying in response to dexloxiglumide and placebo were assessed.RESULTS: Dexloxiglumide was associated with accelerated gastric emptying t1/2 (p= 0.004), and slower ascending colon emptying t1/2 (p<0.01), with no significant effect on overall CT or satisfactory relief of IBS. There was an association between CCK 779T>C polymorphism and slower rate of gastric emptying (p= 0.04).CONCLUSIONS: Dexloxiglumide accelerates gastric emptying and delays proximal but not overall CT in patients with C-IBS. Dexloxiglumide does not accelerate transit in C-IBS. The role of CCK-1 gene polymorphisms in delaying gastric emptying and in determining response to therapy deserves further study.(Am J Gastroenterol 2005;100:652–663) [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Probiotics for the prevention and treatment of antibiotic-associated diarrhea: A systematic review and meta-analysis" by S. Hempel and colleagues in the 2012 issue.