Effects of octreotide on manometric variables in patients with neuropathic abnormalities of the small bowel.

At present, there are few therapeutic options inpatients with chronic intestinal dysmotilities.Octreotide, a long-acting somatostatin analog, hasrecently been shown to be a potentially useful drug in this setting, being able to start activityfronts (AF) in the small bowel in both healthy subjectsand patients with intestinal motor disorders. We studiedthe effects of octreotide on manometric variables in 10 patients with chronic uppergastrointestinal symptoms and an intrinsic neuropathicdisorder of the small intestine. Gastrointestinalmanometry was carried out for 6 hr during fasting and 2hr after a standard 605-kcal mixed meal. Thereafteroctreotide, 50 μg subcutaneously was administered andthe recording session continued for a further hour.Analysis of the tracings during fasting showed that 44% of the AF were abnormal; octreotidesignificantly increased the hourly number of AF (2± 0.26 vs 0.67 ± 0.14, P < 0.0001) andtheir duration (8.33 ± 1.3 vs 6.12 ± 0.34min, P < 0.05) with respect to the baseline (fasting) period, and the propagation velocityalso significantly slowed (3.4 ± 0.4 vs 11± 0.6 cm/min, P < 0.05). After the drug, 80%of patients displayed two AF and 10% more than two AF;the first AF after octreotide was always abnormally propagated. Analmost complete inhibition of small bowel postprandialcontractile activity was observed in 80% of patients,and the remaining 20% showed decreases. In three subjects, octreotide injection evoked theappearance of pylorospasm. From these results weconclude that octreotide could be of some benefit inpatients with neuropathic disorders of the small bowel,although it remains to be established whether it is mostuseful in patients with more severe conditions,characterized by the complete absence of AF. Theappearance of pylorospasm may contribute to the delayedgastric emptying observed after the drug isadministered.