Octreotide in refractory functional epigastric pain with nutritional impairment—an open study

Abstract

Aim : To test the therapeutic efficacy of octreotide administered subcutaneously for the relief of chronic refractory epigastric pain severe enough to provoke nutritional impairment. Subjects and methods : Seventeen patients were enrolled in an open trial. Epigastric pain had lasted from 1 to 8 years (median: 5 years), following anti‐reflux surgery in eight patients. Median weight loss was 10% (range 10–15). The initial dose of octreotide was 50 μg b.d, adjusted during the follow‐up visits which were scheduled for months 1, 3, 6, 8, 10, 12 and every 3 months. At each visit, overall symptomatic improvement, frequency and intensity of symptoms were checked on a 10‐cm visual analogic scale. Results : At month 1, a progressive improvement of pain intensity was reported in 15 of the 17 patients, while octreotide was a therapeutic failure in two. In four out of 15, the daily dose of octreotide was increased to 100 μg b.d. In these 15 patients, median follow‐up was 7 months (3–27). The symptomatic benefit was maintained in each patient at month 3, with a median weight gain of 3.5 kg.2–5 An attempt to stop octreotide led to recurrence of symptoms in 2–3 days which were as intense as before the treatment. The 11 patients followed‐up for at least 6 months reported persistent improvement of symptoms with octreotide and a median weight gain of 4 kg.3–7 Four patients were followed up for more 11–27 months: octreotide was withdrawn gradually in two who remained asymptomatic. Six of the 17 patients experienced minor side‐effects, but none developed biliary sludge. Conclusions : This open study suggests that octreotide could be a promising alternative treatment when all others fail in refractory chronic functional epigastric pain severe enough to limit food intake and to induce nutritional impairment. These results must be tested by a placebo‐controlled study.

Drug Management of Visceral Pain: Concepts from Basic Research

“…Octreotide as an adjuvant to morphine reduced pain in a cohort of individuals with gastrointestinal cancers [194]. Octreotide relieved severe refractory epigastric pain in individuals with weight loss and functional bowel disorders [195]. Unfortunately, octreotide did not reduce pain from pancreatitis [196].…”

Concomitant variations of gastric tone and duodenal motility in humans: Results of a placebo-controlled study assessing octreotide and sumatriptan

“…However, in the interdigestive state, it could be assumed that octreotide induces proximal stomach relaxation, inhibits normal reflex responses of gastric volume increase, and decreases the number and amplitude of volume waves. The last two points are important ones to consider when drawing attention to the possible therapeutic use of octreotide to relieve the symptoms of patients with refractory epigastric pain, as suggested in a small uncontrolled series [15]. It could be speculated that both motor and sensory effects might be implicated in explaining a favourable symptomatic effect.…”

Augmented visceral perception

“…• Similarly, the somatostatin analog octreotide blunts the perception of gastric distention [60]. Preliminary investigations suggest that this agent may be of some use in patients with refractory dyspeptic symptoms [13]. • In separate studies, nitroglycerin, clonidine (an alpha-2 adrenoceptor agonist), sumatriptan, and buspirone (5-HT 1 receptor agonists), have been shown to produce prominent gastric fundus relaxation [17][18][19][20][21].…”