Alvimopan (Entereg®) reduced complications from the temporary loss of gastrointestinal function that follows bowel resection surgery (post-operative ileus).  Compared to colorectal cancer patients who received a placebo, hospital stays were shorter, time to bowel recovery was faster, and there were fewer complications from ileus.

James L. Weese M.D. and colleagues analyzed four randomized, double-blinded clinical trials with over 700 patients that compared alivimopan to a placebo in patients undergoing bowel resection.  Patients were all scheduled to have their post-operative pain managed by intravenous opioids via a PCA (patient-control analgesia) pump.  His analysis looked specifically at bowel resection for colorectal cancer.

Patients with nasal gastric tubes had them removed on the first day after surgery.  They were encouraged to begin walking that day.  Solid food was offered on the second post-operative day.

Patients who received alvimopan

  • Had a faster GI recovery:  were able to tolerate solid food and have their first bowel movement sooner
  • Had a shorter hospital stay:  Colorectal cancer patients left the hospital in an average of 5.7 days on alvimopan as opposed to staying 7.1 days if they were getting a placebo.
  • Had fewer post-operative ileus-related complications including needing a nasal gastric tube reinserted, having a prolonged hospital stay, or having to be readmitted to the hospital.
  • Had less nausea, vomiting, diarrhea, and fever.

Alvimopan blocks the activity of opioid drugs such as morphine on the intestinal tract without interfering with pain control.

More than 250,000 people undergo bowel resection each year in the United States, a majority of them as part of colorectal cancer treatment.  Post-operative ileus is a temporary cession of normal gastrointestinal function, and occurs to some extent after all bowel resections. 

Post-operative ileus

  • Delays the passage of intestinal gas (flatus) and stool.
  • Makes it difficult for patients to eat solid food.
  • Causes abdominal distension and bloating.
  • Increases nausea and vomiting.
  • Can be made worse by opioid pain relievers

SOURCE:  Abstract #4014 ASCO 2007 Poster Display/Discussion

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