Gastrointestinal Side-Effects of Octreotide during Long Term Treatment of Acromegaly*

Abstract

Gastrointestinal side-effects of prolonged therapy (greater than 2 yr) with the long-acting somatostatin analog octreotide were studied in 10 acromegalic patients. After 2 yr of therapy, 6 of 10 patients had newly developed gallstones, complicated by cholangitis and jaundice in 1. Serum vitamin B-12 concentrations declined in all 10 patients [from 380 +/- 32 to 172 +/- 21 pmol/L (mean +/- SE); P = 0.023] and became abnormally low in 4. Gastric biopsy specimens, obtained during gastroscopy (9 patients), showed moderate to severe active gastritis, with damage to the superficial and deeper layers of the mucosa in 9 of 9 and focal atrophy in 7 of 9 patients. Campylobacter pylori was found in the antral mucosa in 8 of 9 patients. Although information is lacking on similar studies in untreated acromegalic patients, we suggest that patients receiving chronic octreotide therapy be closely monitored for these and possible other side-effects related to gastrointestinal actions of octreotide.

Management of patients with differentiated neuroendocrine tumors of jejunum and ileum (according to international guidelines)

“…Эффективность ланреотида и октреотида сопоставима [65,66,70]. Незна чительные начальные побочные эффекты включают временный дискомфорт в брюш ной полости, иногда стеаторею (корригируе мую пероральными ферментами) [61,66,67,75]. Более чем у 50% больных появляются желчные камни (чаще всего бессимптомные) [75].…”

“…Незна чительные начальные побочные эффекты включают временный дискомфорт в брюш ной полости, иногда стеаторею (корригируе мую пероральными ферментами) [61,66,67,75]. Более чем у 50% больных появляются желчные камни (чаще всего бессимптомные) [75]. С целью профилактики карциноидного криза аналоги соматостатина следует вво дить внутривенно во время анестезии или при других инвазивных процедурах.…”

“…Стеаторея может при вести к нарушению всасывания витамина D и соответственно кальция [75]. При длитель ном получении аналогов соматостатина не обходим контроль уровня витамина В 12 , так как он может быть снижен.…”

Effect of the somatostatin analog octreotide on gastric mucosal function and histology during 3 months of preoperative treatment in patients with acromegaly

“…We have shown previously that longterm (several years) octreotide treatment of acromegalic patients carries a risk of chronic active gastritis, although its incidence is a matter of discussion (14)(15)(16). Both a direct antiproliferative effect (27) of octreotide and inhibition of trophic factors (gastrin, histamine) (36,42) could weaken the physiological gastric mucosal regeneration.…”

“…Both atrophic gastritis and H. pylori infection are potentially precancerous conditions (10)(11)(12)(13). However, the significance of octreotide-induced changes and their consequences during long-term treatment are not entirely clear (14)(15)(16), and their development during short-term (e.g. preoperative) treatment has not been studied.…”