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.
- [Show abstract] [Hide abstract]
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.01/1992; 4(3). DOI:10.1007/BF03259208
- [Show abstract] [Hide abstract]
ABSTRACT: Severe long-term complaints of dumping occur in a small number of patients after gastric surgery. Dietary modification, fiber preparations, and medical therapy are often ineffective. In these severely affected patients administration of the somatostatin analog octreotide before meals appears to be a promising new strategy. The effects of octreotide on both gastrointestinal transit time and hormonal changes appear to contribute to the benefits seen in dumping syndrome. However, as the majority of studies conducted have employed only a single dose of octreotide, careful long-term assessment of the nutritional and metabolic effects will be required. Recent results suggest that octreotide may be administered up to 2 hr before a meal and therefore has a sufficiently long duration of action to be of practical long-term use. Moreover, general improvements in life-style, as well as beneficial effects on symptoms, have been reported with long-term treatment, although the potential development of diarrhea will require careful monitoring. The development of an oral or nasal formulation should further improve the practical application of octreotide as a treatment for dumping syndrome.Digestive Diseases and Sciences 03/1993; 38(2):359-64. DOI:10.1007/BF01307556 · 2.55 Impact Factor
Article: Expanding uses of octreotide.[Show abstract] [Hide abstract]
ABSTRACT: This chapter reviews the therapeutic use of octreotide in a variety of pancreatic disorders, including acute pancreatitis, in the prevention of postoperative and post-ERCP pancreatitis, in the control of postoperative pancreatic fistulae, and in chronic pancreatitis for the control of pain and of pseudocysts and ascites. The review also discusses the use of octreotide in intestinal disorders of motility, gastrointestinal bleeding, intestinal fistulae and refractory diarrhoea, including the diarrhoeas of AIDS, diabetes, short gut, chemotherapy, ileostomy and gastric surgery. The use of octreotide in neuroendocrine tumours, both for therapy and diagnostic imaging, is reviewed briefly. The paucity of adequately controlled studies in many of these situations is indicated and the potential usefulness of octreotide estimated.Baillière s Clinical Gastroenterology 07/1994; 8(2):321-37. DOI:10.1016/0950-3528(94)90007-8