Introduction

Malignant bowel obstruction (MBO) is relatively common, with up to 15% of patients with malignancy suffering from an MBO during their cancer journey.1 2 The management of an MBO in palliative care for patients who are not for surgical intervention may involve medication to decrease secretory load in the gastrointestinal (GI) tract, treating nausea, pain and acid-reflux symptoms. Medications used often include an anticholinergic such as hyoscine butylbromide or glycopyrronium, a somatostatin analogue such as octreotide, a steroid such as dexamethasone and until recently, the histamine-2 receptor antagonist ranitidine.1

There is conflicting evidence around the efficacy of many of these interventions. The use of octreotide has been questioned by a well-run randomised control trial,3 although limitations in the study timeframe and maximum dose have been raised. The use of ranitidine has also a questionable evidence base, being drawn primarily from meta-analysis of the anaesthetic literature.4 There is however biological plausibility for the usage of medicines that decrease gastric secretions, and both ranitidine and glycopyrronium have evidence for a substantial decrease.4 There is evidence that proton pump inhibitors (PPIs) decrease gastric secretions, although the provision of PPIs in the palliative setting has been traditionally challenging due to the requirement for oral …