Octreotide increases thresholds of colonic visceral perception in IBS patients without modifying muscle tone

Abstract

Effects of octreotide (1.25 micrograms/kg subcutaneously) on colonic tone and visceral perception were evaluated in 10 IBS patients, using a barostat and compared to placebo in a double-blind crossover study. Colonic sensory thresholds were also studied in healthy controls for comparison with IBS patients. Colonic tone was reflected by variations in volume of the barostat balloon. Baseline volume was 117 +/- 38 ml and was not modified by placebo (122 +/- 40 ml) or octreotide (106 +/- 42 ml). After the meal, maximal decrease in balloon volume was 75 +/- 4% following placebo (P < 0.001) beginning after 9 +/- 3 min and lasting 136 +/- 17 min. Following octreotide, the maximal decrease was 69 +/- 16% (NS vs placebo), after 10 +/- 3 min and lasting 140 +/- 22 min. In the second part, discomfort and pain thresholds were evaluated during isobaric distensions (4 mm Hg increments, 5-min duration, 5-min interval with return to pressure 0 between each). The pressure inducing discomfort was 21.2 +/- 5.9 mm Hg following placebo vs 29.6 +/- 6.6 mm Hg following octreotide (P < 0.01). The pressure inducing pain was 24.8 +/- 7.3 mm Hg following placebo vs 33.2 +/- 7.3 mm Hg following octreotide (P < 0.01). In healthy subjects, discomfort and pain were induced by colonic distensions at a mean intraballoon pressure of 32.7 +/- 5.8 mm Hg and 36.7 +/- 3.9 mm Hg, respectively. Compliance curves were not different following placebo and octreotide. Octreotide significantly increases thresholds for visceral perception in IBS patients without modifying compliance during distension nor colonic tone.

Review article: modulation of the brain–gut axis as a therapeutic approach in gastrointestinal disease

“…98 A schematic of receptor targets for SST receptor agonists is shown in Figure 2. In humans, octreotide, a non-selective SST2, SST3 and SST5 receptor agonist, has been demonstrated to have potent viscero analgesic, [99][100][101] as well as GI motility, effect. 102 Several pharmacodynamic studies have…”

“…[99][100][101][103][104][105][106] Preliminary evidence from an 8-week controlled clinical treatment trial 107 showed that octreotide treatment was associated with a reduction in the perception of barostat-induced rectal distension in non-constipated IBS patients. In addition, octreotide treatment was found to reduce the abdominal complaints and improve the stool consistency, suggesting an overall beneficial effect.…”

Visceral Perception in Functional Gastro-Intestinal Disorders: Disease Marker or Epiphenomenon?

“…Preliminary data have sug gested efficacy in the treatment of functional dyspepsia [103,104], and it has been shown to block the effects of intraduodenal fat on de laying gastric emptying [105]. Octreotide, a somatostatin analogue, has increased colonic thresholds to discomfort and pain without modifying tone [106]. Fedotozine, a peripher al kappa opioid receptor agonist, has been shown to modulate the cologastric reflex pro duced by intraluminal balloon distension in dogs [107], In the human colon, it also ap pears to increase pain thresholds [108].…”

Novas drogas no tratamento da dispepsia funcional

“…A octreotida, análogo sintético do hormônio natural somatostatina, em injeção subcutânea, aumenta significativamente o limiar para a percepção da distensão do intestino grosso em pacientes com a síndrome do intestino irritável (6) , sendo, porém, incerto se afeta a sensibilidade gastroduodenal em pacientes com a dispepsia funcional.…”