Clinical Question: Does oral therapy with magnesium oxide, Lactobacillus acidophilus, and simethicone (Mylanta) improve outcomes in patients with partial small bowel obstruction?
Setting: Inpatient (any location)
Study Design: Randomized controlled trial (single-blinded)
Synopsis: Partial small bowel obstruction is a relatively common long-term complication of intra-abdominal and pelvic surgery, with up to one third of patients requiring surgical decompression. In this study, the researchers identified 128 Taiwanese adults with a history of abdominal surgery more than four weeks before the study began, symptoms consistent with partial small bowel obstruction, and a confirmatory radiograph showing air-fluid levels in the small bowel but only air in the large bowel. Allocation was concealed, and an attempt was made to blind the attending surgeon who made the decisions about treatment and length of stay. Groups were balanced at the start of the study, and no patients were lost to follow-up. All patients received intravenous hydration and nasogastric tube decompression. Those in the control group received nothing by mouth, whereas those in the treatment group received water and 500 mg magnesium oxide, 0.3 g of L. acidophilus, and 40 mg simethicone three times daily followed by clamping of the tube for one hour. Patients in the active treatment group were less likely to require surgery (9 versus 24 percent; P = .03; number needed to treat = 7; 95% confidence interval, 4 to 52) and had a shorter length of stay (1.0 versus 4.2 days; P < .001). There was no difference between groups in the likelihood of serious complications or recurrence within six months. The main limitations of the study were the failure to blind patients and caregivers and the difficulty in blinding the attending surgeon.
Bottom Line: The combination of magnesium oxide, L. acidophilus, and simethicone appears to reduce length of stay and the need for surgery in patients with partial small bowel obstruction, although this study was limited by a failure to completely blind patients and their caregivers. (Level of Evidence: 1b)