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1. Constipation and diarrhoea

Author

Nigel P. Sykes

Abstract

Constipation is far more common in palliative care than diarrhoea and results not just from the use of opioids but also from the multifactorial effects of debility secondary to disease. Most palliative care patients will require regular administration of an oral laxative in a dose titrated against response, with the aim of avoiding the use of suppositories or enemas if possible as these are less liked. The lack of clear differences in laxative efficacy means that cost and patient choice are key factors in guiding treatment. Diarrhoea in palliative care most often results from excess laxative or from common infections that can be simply managed. Bowel shortening or diversion causes more resistant diarrhoea. Cytotoxic chemotherapy can lead to diarrhoea either as an adverse effect of treatment or from potentially life-threatening neutropenic colitis.

Published
2015
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2. Clinical aspects of palliative sedation

Author

Nigel P. Sykes

Subjects
Medico legal, medicine.medical_specialty, Existential distress, business.industry, Continuous sedation, Sedation, medicine, Midazolam, medicine.symptom, business, Intensive care medicine, Palliative sedation, medicine.drug
Published
2013
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3. Herausgeber und Autoren

Author

Peter Nieland, Rainer Simader, Jenny Taylor, Claudia Bausewein, Jacob van den Broek, Sinead Cobbe, Kristina Coe, Ylva Dahlin, John E. Ellershaw, Gail Eva, Brigitte Fiechter Lienert, Andrew F. Goodhead, Elisabeth Grünberger, Nigel Hartley, Bronwen Hewitt, Louis Hollander, Birgit Jaspers, Rebecca Jennings, In-Sun Kim, Michael- M. Lippka, Lorna Malcolm, Tamsin McGlinchey, Eva Müllauer, Kate Norman, Christina Plath, Klaus Reckinger, Wolf Schönleiter, Sabine Schraut, and Nigel P. Sykes

Published
2013
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4. A volunteer model for the comparison of laxatives in opioid-related constipation

Author

Nigel P. Sykes

Subjects
Adult, medicine.medical_specialty, Abdominal pain, Loperamide, Constipation, Adolescent, medicine.medical_treatment, Laxative, Cathartic, Gastroenterology, Lactulose, Internal medicine, medicine, Humans, Antidiarrheals, General Nursing, Aged, Cathartics, business.industry, digestive, oral, and skin physiology, Middle Aged, Anesthesiology and Pain Medicine, Opioid, Anesthesia, Defecation, Drug Therapy, Combination, Female, Neurology (clinical), medicine.symptom, business, medicine.drug
Abstract

Loperamide was used to provide a source of opioid-induced constipation in healthy volunteers. Each volunteer took a sequence of three dose levels of loperamide. One of three laxatives was used to counterbalance the effect of loperamide and restore bowel function to what the individual considered normal at each stage before the dose of loperamide was increased. Lactulose, senna, and codanthrusate were selected as examples of a softening, a stimulant, and a combination laxative, respectively. Outcome measures were the doses of laxative used, stool form and frequency, ease of defecation, a rating scale of subjective bowel function, and the occurrence of adverse effects. Each laxative was taken by ten volunteers, and all proved capable of maintaining normal bowel function. A combination of stimulant and softening laxatives was most likely to maintain normal bowel function at the lowest dose and least adverse effects. The mean final dose of lactulose was excessive for use in ill patients. Senna was associated with significantly more adverse effects than the other laxatives, mainly abdominal pain (P < 0.001). This model of constipation may provide a standardized means of assaying the clinical effectiveness of oral laxatives.

Published
1996
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6. Contributors

Author

Amy P. Abernethy, Douglas G. Adler, Yesne Alici, Eugene Balagula, Ani Balmanoukian, Nikhil Banerjee, Gerhild Becker, Virginia Boquiren, Julie R. Brahmer, William Breitbart, Michael T. Brennan, Eduardo Bruera, Marianne Brydøy, Robert Buckman, Amanda Caissie, Joseph R. Carver, Harvey M. Chochinov, Edward Chow, Ai-Ping Chua, Maureen E. Clark, Raimundo Correa, Kerry S. Courneya, David C. Currow, Shalini Dalal, Mellar P. Davis, Maike de Wit, Haryana Dhillon, Mario Dicato, Ingo J. Diel, Jason E. Dodge, Matthew Doolittle, Wolfgang Dörr, Geoffrey P. Dunn, Alexandra M. Easson, Edzard K. Ernst, Petra Ch. Feyer, David R. Fogelman, Sophie D. Fosså, Orit Freedman, Debra L. Friedman, Surafel Gebreselassie, Thomas R. Gildea, Marc Giovannini, Paul A. Glare, Arin K. Greene, Janet R. Hardy, Daniel B. Hinshaw, Ulrike Hoeller, Juliet Hou, Lynn Jedlicka, Siri Beier Jensen, Katherine T. Johnston, Jason M. Jones, Karin Jordan, Karunakaravel Karuppasamy, Raghid Kikano, Kenneth L. Kirsh, Cecilie Kiserud, David W. Kissane, Małgorzata Krajnik, Christof Kramm, Sheldon Kwok, Mario E. Lacouture, Abraham Levitin, Madeline Li, S. Lawrence Librach, Wendy G. Lichtenthal, Isador Lieberman, Vernon W.H. Lin, Hartmut Link, Christopher Lo, César V. Lopes, Charles L. Loprinzi, Amy E. Lowery, Robert Mader, Henriette Magelssen, Vincent Maida, H.A. Marsman, Susan E. McClement, Erin L. McGowan, Daniel J. Moskovic, Marissa Newman, Tanya Nikolova, Jan Oldenburg, Petra Ortner, Dierdre R. Pachman, Jocelyn Pang, Steven D. Passik, Timothy M. Pawlik, Júlio C. Pereira-Lima, Douglas E. Peterson, Barbara F. Piper, Laurent Plawny, Kathy Pope, Jennifer Potter, Holly G. Prigerson, Carla I. Ripamonti, Lizbeth Robles, Gary Rodin, Lisa Ruppert, Brenda M. Sabo, Nadia Salvo, Jose Fernando Santacruz, Josée Savard, Carolyn C. Schook, Dale R. Shepard, Heather L. Shepherd, Sumner A. Slavin, Martin L. Smith, Fred K.L. Spijkervet, Glen H.J. Stevens, Michael D. Stubblefield, Nigel P. Sykes, Matthew Tam, Martin H.N. Tattersall, Mary L.S. Vachon, A.E. van der Pool, T.M. van Gulik, Janette Vardy, Cornelis Verhoef, Arjan Vissink, Hans-Heinrich Wolf, Rebecca K.S. Wong, Camilla Zimmermann, and Zbigniew Zylicz

Published
2011
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7. Constipation and Diarrhea

Author

Nigel P. Sykes

Subjects
medicine.medical_specialty, Diarrhea, Constipation, business.industry, Internal medicine, medicine, medicine.symptom, business, Gastroenterology
Published
2009
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8. CONTRIBUTORS

Author

Judith A. Aberg, Amy P. Abernethy, Janet L. Abrahm, Michael Adolph, Michael Aherne, K. Allsopp, Rogelio Altisent, Carmen Fernandez Alvarez, Pablo Amigo, Wendy G. Anderson, Sik Kim Ang, Tiziana Antonelli, John Armstrong, Wendy S. Armstrong, Robert M. Arnold, Pilar Arranz, Koen Augustyns, Isabel Barreiro-Meiro Sáenz-Diez, Pilar Barreto, Debra Barton, Ursula Bates, Maria B. Fernandez-Creuchet Santos, Jacinto Bátiz, Costantino Benedetti, Nabila Bennani-Baiti, Michael I. Bennett, Kevin Berger, Mamta Bhatnagar, Lesley Bicanovsky, Lynda Blue, Barton Bobb, Jean-Jacques Body, Gian Domenico Borasio, Claudia Borreani, Federico Bozzetti, Valentina Bozzetti, Jason Braybrooke, William Breitbart, Barry Bresnihan, Bert Broeckaert, Eduardo Bruera, Kay Brune, Bradley Buckhout, Phyllis N. Butow, Ira Byock, Anthony Byrne, Clare Byrne, Beryl E. Cable-Williams, Sarah E. Callin, David Casarett, David Casper, Eric J. Cassell, Barrie Cassileth, Emanuele Castagno, Carlos Centeno, Walter Ceranski, Lucas Ceulemans, Meghna Chadha, Bruce H. Chamberlain, Eric L. Chang, Victor T. Chang, Harvey Max Chochinov, Edward Chow, Grace Christ, Katherine Clark, Stephen Clarke, Josephine M. Clayton, James F. Cleary, Lawrence J. Clein, Katri Elina Clemens, Libby Clemens, Robert Colebunders, Steven R. Connor, Viviane Conraads, Colm Cooney, Massimo Costantini, Azucena Couceiro, Holly Covington, John D. Cowan, Patrick Coyne, Garnet Crawford, Brian Creedon, Hilary Cronin, Garret Cullen, Jennifer E. Cummings, David C. Currow, Paul J. Daeninck, Pamela Dalinis, Prajnan Das, Mellar P. Davis, Sara N. Davison, Catherine Deamant, Liliana de Lima, Conor P. Delany, Peter Demeulenaere, Lena Dergham, Noël Derycke, Rajeev Dhupar, Mario Dicato, Edwin D. Dickerson, Andrew Dickman, Maria Dietrich, Pamela Dixon, Philip C. Dodd, James T. D'Olimpio, Per Dombernowsky, Michael Dooley, Deborah Dudgeon, Geoffrey P. Dunn, David Dunwoodie, Jane Eades, Badi El Osta, Katja Elbert-Avila, John Ellershaw, Bassam Estfan, Louise Exton, Alysa Fairchild, Matthew Farrelly, Konrad Fassbender, Jason Faulhaber, Kenneth C.H. Fearon, Lynda E. Fenelon, Peter F. Ferson, Petra Feyer, Marilene Filbet, Pam Firth, Susan F. FitzGerald, Hugh D. Flood, Francesca Crippa Floriani, Paul J. Ford, Barry Fortner, Darlene Foth, Bridget Fowler, Karen Frame, Thomas G. Fraser, Fred Frost, Michael J. Fulham, Pierre R. Gagnon, Lisa M. Gallagher, Maureen Gambles, Subhasis K. Giri, Paul Glare, Cynthia R. Goh, Xavier Gómez-Batiste, Leah Gramlich, Luigi Grassi, Phyllis A. Grauer, Claire Green, Gareth Griffiths, Yvona Griffo, Hunter Groninger, David A. Gruenewald, Jyothirmai Gubili, Terence L. Gutgsell, Elizabeth Gwyther, Paul S. Haber, Achiel Haemers, Mindi C. Haley, Mazen A. Hanna, Janet R. Hardy, Jodie Haselkorn, Katherine Hauser, Cathy Heaven, Michael Herman, Jørn Herrstedt, Stephen Higgins, Irene J. Higginson, Joanne M. Hilden, Kathryn L. Hillenbrand, Burkhard Hinz, Jade Homsi, Kerry Hood, Juliet Y. Hou, Guy Hubens, Peter Hudson, John G. Hughes, John Hunt, Craig A. Hurwitz, James Ibinson, Nora Janjan, Birgit Jaspers, Thomas Jehser, A. Mark Joffe, Laurence John, Jennie Johnstone, J. Stephen Jones, Javier R. Kane, Matthew T. Karafa, Andrew P. Keaveny, Dorothy M.K. Keefe, Catherine McVearry Kelso, Rose Anne Kenny, Martina Kern, Dilara Seyidova Khoshknabi, Jordanka Kirkova, Kenneth L. Kirsh, David W. Kissane, Eberhard Klaschik, Seref Komurcu, Kandice Kottke-Marchant, Kathryn M. Kozell, Sunil Krishnan, Deborah Kuban, Damian A. Laber, Ruth L. Lagman, Rajesh V. Lalla, Deforia Lane, Philip J. Larkin, Wael Lasheen, Peter Lawlor, Susan B. LeGrand, Vincent Lens, Dona Leskuski, Pamela Levack, Marcia Levetown, Jeanne G. Lewandowski, William R. Lewis, S. Lawrence Librach, Wendy G. Lichtenthal, J. Norelle Lickiss, Stefano Lijoi, Edward Lin, Arthur G. Lipman, Jean-Michel Livrozet, Mari Lloyd-Williams, Richard M. Logan, Francisco López-Lara Martín, Charles L. Loprinzi, John Loughnane, Michael Lucey, Laurie Lyckholm, Carol Macmillan, Frances Mair, Stephen N. Makoni, Bushra Malik, Kevin Malone, Marco Maltoni, Aruna Mani, Lucille R. Marchand, Darren P. Mareiniss, Anna L. Marsland, Joan Marston, Julia Romero Martinez, Isabel Martínez de Ubago, Lina M. Martins, Timothy S. Maughan, Catriona Mayland, Susan E. McClement, Ian McCutcheon, Michael F. McGee, Neil McGill, Stephen McNamara, Mary Lynn McPherson, Henry McQuay, Regina McQuillan, Robert E. McQuown, Michelle Meiring, Sebastiano Mercadante, Elaine C. Meyer, Randy D. Miller, Yvonne Millerick, Roberto Miniero, Armin Mohamed, Busi Mooka, Helen M. Morrison, J. Cameron Muir, Fiona Mulcahy, Hugh E. Mulcahy, Monica Muller, H. Christof Müller-Busch, Scott A. Murray, Friedemann Nauck, Katherine Neasham, Busisiwe Nkosi, Simon Noble, Antonio Noguera, Anna K. Nowak, Juan Nuñez-Olarte, Eugenie A.M.T. Obbens, Tony O'Brien, Megan Olden, Norma O'Leary, David Oliver, David Oliviere, Aurelius G. Omlin, Kaci Osenga, Diarmuid O'Shea, Christophe Ostgathe, Faith D. Ottery, Michel Ouellette, Edgar Turner Overton, Moné Palacios, Robert Palmer, Teresa Palmer, Carmen Paradis, Armida G. Parala, Antonio Pascual-López, Steven D. Passik, Timothy M. Pawlik, Malcolm Payne, Sheila Payne, Silvia Paz, José Pereira, George Perkins, Karin Peschardt, Hayley Pessin, Douglas E. Peterson, Vinod K. Podichetty, Robin Pollens, Eliza Pontifex, Susan Poole, Josep Porta-Sales, Graeme Poston, Ruth D. Powazki, William Powderly, Leopoldo Pozuelo, Eric Prommer, Christina M. Puchalski, Lukas Radbruch, David F.J. Raes, Jane Read, Anantha Reddy, Steven I. Reger, Susan J. Rehm, Stephen G. Reich, Javier Rocafort, Adam Rosenblatt, Cynda Hylton Rushton, K. Mitchell Russell, Karen Ryan, Lisa A. Rybicki, Paola Sacerdote, Vinod Sahgal, Mary Ann Sammon, Dirk Sandrock, Mark Sands, Denise L. Schilling, Valerie Nocent Schulz, Lisa N. Schum, Peter Selwyn, Joshua Shadd, Charles L. Shapiro, Aktham Sharif, Helen M. Sharp, Kirk V. Shepard, J. Timothy Sherwood, Nabin K. Shrestha, Richard J.E. Skipworth, Howard S. Smith, Mildred Z. Solomon, Diego Soto de Prado Otero, Denise Wells Spencer, Ron Spice, David Spiegel, Manish Srivastava, John N. Staffurth, Randall Starling, Grant D. Stewart, Jan Stjernswärd, Florian Strasser, Edna Strauss, Imke Strohscheer, Brett Taylor Summey, Graham Sutton, Nigel P. Sykes, Alan J. Taege, Marcello Tamburini, Yoko Tarumi, Davide Tassinari, Martin H.N. Tattersall, Karl S. Theil, Keri Thomas, Adrian Tookman, María P. Torrubia, Anna Towers, Daphne Tsoi, Rodney O. Tucker, James A. Tulsky, Rachel A. Tunick, Claire Turner, Martha L. Twaddle, Marie Twomey, Christina Ullrich, Catherine E. Urch, Mary L.S. Vachon, Bart Van den Eynden, Antonio Vigano, Erika Vlieghe, Angelo E. Volandes, Raymond Voltz, Paul W. Walker, Sharon Watanabe, Michael A. Weber, Elizabeth Weinstein, Sharon M. Weinstein, Kathryn L. Weise, Sherri Weisenfluh, John Welsh, Clare White, Donna M. Wilson, Joanne Wolfe, Tugba Yavuzsen, Albert J.M. Yee, Lisa M. Yerian, and Elena Zucchetti

Published
2009
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10. The pathogenesis of constipation

Author

Nigel P, Sykes

Subjects
Intestines, Risk Factors, Neoplasms, Age Factors, Humans, Gastrointestinal Motility, Constipation, Exercise, Diet
Abstract

The pathogenesis of the constipation that is commonly experienced by cancer patients, especially those with advanced disease, is the result of multiple influences on the control of intestinal motility and fluid handling. These factors include the direct effects of malignancy on gut structure, paraneoplastic neural impairment, biochemical disturbance, and adverse effects of cancer treatments. In addition, the debility and reduced oral intake associated with cancer also contribute, as, perhaps, might the older age of many cancer patients. A detailed understanding of the mechanisms of constipation, especially in association with illness, is lacking, and most treatments remain nonspecific.

Published
2006

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