Octreotide in Dumping and Short Bowel Syndromes

Abstract

Octreotide inhibits intestinal motility and reduces gastrointestinal secretions. These actions have led to its evaluation in two postsurgical conditions: dumping syndrome and short bowel syndrome. Octreotide substantially reduces symptoms of early and late dumping and prevents the associated phenomena including the increase in packed cell volume considered to be indicative of reduced plasma volume. Its therapeutic benefit probably relates both to slowing of gastric emptying and small bowel transit and inhibition of the release of putative mediators (peptide hormones) of the vasomotor symptoms. Octreotide also reduces intestinal efflux in some patients with the short bowel syndrome. This can lead to a reduction in the volume of intravenous fluid requirements but does not allow an intravenous fluid-dependent patient to change back to an oral regimen. The major mechanism of octreotide’s therapeutic effect in this situation may be its ability to reduce endogenous gastric acid secretion.

Do Gut Hormones Contribute to Weight Loss and Glycaemic Outcomes after Bariatric Surgery?

“…As octreotide has non-specific effects to block gut hormone secretion, it is difficult to identify the main gut hormones contributing to food intake and appetite changes after RYGB. Moreover, octreotide has an inhibitory effect on gastrointestinal motility [129], which may improve postprandial symptoms and affect further the appetite postoperatively.…”

Management of Intestinal Failure: The High-Output Enterostomy and Enterocutaneous Fistula

“…4 Antisecretory medications such as proton-pump inhibitors, histamine blockers, and somatostatin analogue (octreotide) may be added in a stepwise algorithm to further reduce gut secretions and may be particularly useful when output from the enterostomy exceeds oral intake. 4,[17][18][19] Beneficial evidence of the effects of somatostatin on high-output enterostomy is mostly anecdotal and is limited to the early postoperative period.…”

The Role of Somatostatin and Octreotide in Bowel Obstruction: Pre-Clinic Al and Clinical Results

“…However, the reduction of plasma concentrations of the secretagogues may not be the exclusive mechanism of action of somatostatin in vivo. Octreotide has been used clinically to treat a variety of diseases including carcinoid syndrome 50 -52 , acromegaly 50 • 53 , Zollinger-Ellison syndrome 54 , AIDS-related diarrhea 55 , dumping and short bowel syndromes 56 , and a variety of endocrine tumors 43 • 49 • The inhibitory effect of octreotide on peristalsis and GI secretions brings about a reduction in the distension of the bowel and consequently a decrease in water and sodium secretion of the intestinal epithelium, thereby reducing vomiting and pain 23 • Octreotide acts by breaking the vicious circle represented by secretion-distension-contractile hyperactivity. Oc-treotide has been shown to have a potent anti-VIP effect, resulting in the inhibition of intestinal secretion 44 • 57 • It reduces GI contents owing to a reduction of secretion and an increase in the absorption of water and electrolytes at intracellular levels through inhibition of the formation of cAMP 58 • Another inhibitory mechanism of hormonal release occurs through the activation of a G protein, which, on stimulating the potassium channels, determines the hyperpolarization of the cell, with the consequent blockage of the flux of calcium to the cell 59 .…”