Somatostatin and Its Analogs in the Short Bowel Syndrome

Abstract

The use of somatostatin to manage diarrhea associated with the short gut syndrome is impractical because of its need to be given by continuous infusion and a rebound effect on stool output with cessation of therapy. Octreotide has been used more successfully to control stool and electrolyte losses in patients with shortened gastrointestinal tracts. In published series and studies, all subjects appear to decrease stool losses, but clinical benefit for long-term use is not achieved for all patients. In the patients who do respond, the need for parenteral nutrition and intravenous hydration has been decreased or eliminated. The optimal dose is unclear, but many patients respond to 50-micrograms injections twice daily. Several investigations noted no additional beneficial effects with escalating dosages. Adverse effects include impairment of fat absorption, which may offset the therapeutic benefits of octreotide. The patients with the greatest response appear to have the least fat malabsorption. Other adverse effects noted when using octreotide for control of the short gut syndrome include pain associated with subcutaneous injection and abdominal complaints. Other potential concerns include the effect on gallstone formation in this high-risk population and intestinal adaptation.

Efficacy of octreotide in diarrhoea due toVibrio cholerae: a randomized, controlled trial

“…The results of studies on the efficacy of treatment of various types of secretory diarrhoea with somatostatin and its long-acting analogue, octreotide, have been encouraging. These drugs have been used to treat chronic diarrhoea following ileostomy (Cooper et al, 1986), the diarrhoea of tumours producing vasoactive intestinal polypeptide (Ruskone et al, 1982;Santangelo et al, 1985), carcinoid (Oberg, 1993) and medullary thyroid carcmoma (Smid and Dullaart, 1992), AIDS-related diarrhoea (Manfredi et al, 1993), short-bowel syndrome (Rosen, 1992), dumping syndrome (Lamers et al, 1993) and diabetic diarrhoea (Mourad et al, 1992;Walker and Kaplan, 1993). Octreotide has been used in these studies in doses of 50-lOO f..lg, given subcutaneously every 8-12 h.…”