Long acting somatostatin analogue in dumping syndrome.
ABSTRACT The effect of long acting somatostatin analogue, SMS 201-995, on postprandial dumping syndrome was studied in eight patients with Billroth II gastric resection. Each patient was subjected to two oral glucose challenges with 75 g glucose. One challenge was premedicated with 50 micrograms SMS 201-995 subcutaneously 15 min before the oral intake of glucose, the other with placebo. With placebo all patients experienced the subjective symptoms of the early dumping syndrome with significant (P less than 0.001) increases (mean (s.d.)) in pulse rate (from 66 (8) to 102 (10) beats/min), in packed cell volume (from 0.36 (0.05) to 0.43 (0.1) l/l) and in the plasma levels of vasoactive intestinal polypeptide (from 3.0 (0.5) to 10.2 (1.8) pmol/l). During the somatostatin study the subjective symptoms and the changes in the various parameters were not detected. In the control study seven patients showed postprandial hypoglycemia. In these patients significant elevations (P less than 0.001) in the insulin level (from 10 (0.9) to 40 (9.1) microE/ml) and gastric inhibitory peptide (GIP) concentration (from 100 (13) to 220 (41) ng/l) were seen, compared with the initial values. During the application of SMS 201-995 hypoglycaemia did not develop and plasma insulin and GIP concentrations remained unchanged. These results indicate that the long acting somatostatin analogue alleviates the symptoms of early and late postprandial dumping syndromes.
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ABSTRACT: Octreotide is a long acting synthetic analogue of native somatostatin that exerts a potent inhibitory effect on the release of a wide variety of peptide hormones from the gastroenteropancreatic endocrine system. It represents a new dimension to traditional therapies in the treatment of various conditions characterised by excessive peptide production and secretion, particularly when conventional therapeutic approaches have either been exhausted or have provided suboptimal symptomatic control. While emergency sclerotherapy remains the definitive treatment for both the arrest of acute variceal bleeding episodes and the prevention of further bleeding, its effective use depends on the patients being admitted to a hospital well versed in the procedure. There remains, therefore, a need for an easily administered and effective treatment for acute variceal bleeding emergencies. Although not all investigators agree, it appears that somatostatin is effective, at least for the duration of its administration. Given its evident advantages over somatostatin, octreotide is likely to make a major contribution towards the treatment of variceal bleeding, at least as an emergency treatment during the bleeding crisis. The potential for octreotide in the management of gastrointestinal and pancreatic fistulae is considerable. While sharing the inhibitory actions of native somatostatin on gastrointestinal motility and secretion, it can be administered at home by suitably motivated patients. Suppression of gastrointestinal peptides from the gastrointestinal tract by octreotide appears to parallel symptomatic improvements in patients with dumping syndrome, with normalisation of plasma glucagon and insulin profiles as well as suppression of vasoactive intestinal polypeptide (VIP), motilin, neurotensin, pancreatic polypeptide and C peptide being reported. Release of polypeptide hormones, such as VIP and gastrin, by tumour cells in the gastroenteropancreatic system results in profuse diarrhoea. While the nature of the diarrhoea depends on the specific peptide secreted by the tumour, all possess a common secretory mechanism which makes them sensitive to treatment with octreotide. Octreotide is suitable for the treatment of VIPoma since it inhibits released VIP. Although the available data are derived primarily from small studies and case reports, initial responses are encouraging. By reducing the circulating levels of VIP, octreotide improves diarrhoea in these patients. Octreotide has also been evaluated in several trials in patients with the carcinoid syndrome, with symptomatic improvement being observed in over 75% of cases. Clinically significant improvements in diarrhoea (elimination, or reduction of > 50%) have been observed in the great majority (up to 83%) of treated patients. Slowed tumour growth, as well as an improvement in diarrhoea, has been observed during long term treatment. A number of miscellaneous conditions can give rise to severe secretory diarrhoea, and include long standing neuropathic diabetes mellitus, short bowel syndrome after intestinal resection, intestinal graft-versus-host disease and coeliac plexus block. Idiopathic hypersecretory diarrhoea may also occur, particularly in infants. A number of studies and patient reports have shown octreotide to be a valuable adjunct in the management of patients with such conditions, and to be worthy of further investigation. Now that case report data have been confirmed by clinical trials, it is becoming evident that octreotide is a valuable treatment in the management of otherwise treatment-refractory severe diarrhoea in AIDS patients.Drug Investigation. 01/1992; 4(3).
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ABSTRACT: Unfortunately normal gastrointestinal function after an esophagectomy is rare. Most patients will never eat the way they did before their illness. Most patients require smaller more frequent meals. It is common for patients to loose up to 15% of their body weight from the time of diagnosis through the first 6 months postoperatively, but fortunately this trend levels off after 6 months. Dumping syndrome, delayed gastric emptying, reflux, and dysphagia can all contribute to nutritional deficiency and poor quality of life. There is no one surgical modification to eliminate any one of these complications, but several guidelines can help reduce conduit dysfunction. Most patients seem to benefit from a 5-cm-wide greater-curvature gastric tube brought up through the posterior mediastinum. The gastric-esophageal anastomosis should be placed higher than the level of the azygous vein. Drainage procedures seem to be helpful, especially when using the whole stomach as a conduit. Early erythromycin therapy significantly aids in the function of the gastric conduit. Proton-pump inhibitors are important for improvement of postoperative reflux symptoms and to help prevent Barrett's metaplasia in the esophageal remnant. Single-layer hand-sewn or semi-mechanical anastomoses provide greater cross-sectional area and fewer problems with stricture. When benign strictures occur, early endoscopy and dilation with proton-pump inhibition greatly reduces the morbidity. Patients should be instructed to eat six small meals a day and to remain upright for as long as possible after eating. Simple sugars and fluid at mealtime should be avoided until the function of the conduit is established.Thoracic Surgery Clinics 03/2006; 16(1):53-62.
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ABSTRACT: Dumping syndrome is a frequent complication of esophageal, gastric or bariatric surgery. Rapid gastric emptying, with the delivery to the small intestine of a significant proportion of solid food as large particles that are difficult to digest, is a key event in the pathogenesis of this syndrome. This occurrence causes a shift of fluid from the intravascular component to the intestinal lumen, which results in cardiovascular symptoms, release of several gastrointestinal and pancreatic hormones and late postprandial hypoglycemia. Early dumping symptoms comprise both gastrointestinal and vasomotor symptoms. Late dumping symptoms are the result of reactive hypoglycemia. Besides the assessment of clinical alertness and endoscopic or radiological imaging, a modified oral glucose tolerance test might help to establish a diagnosis. The first step in treating dumping syndrome is the introduction of dietary measures. Acarbose can be added to these measures for patients with hypoglycemia, whereas several studies advocate guar gum or pectin to slow gastric emptying. Somatostatin analogs are the most effective medical therapy for dumping syndrome, and a slow-release preparation is the treatment of choice. In patients with treatment-refractory dumping syndrome, surgical reintervention or continuous enteral feeding can be considered, but the outcomes of such approaches are variable.Nature Reviews Gastroenterology & Hepatology 10/2009; 6(10):583-90. · 10.43 Impact Factor