EFFECT OF OCTREOTIDE ON FLUID AND ELECTROLYTE LOSSES, NUTRIENT ABSORPTION AND TRANSIT IN SHORT-BOWEL SYNDROME

Objective: To study the effect of octreotide, a long-acting somatostat in analogue, on stomal losses and gastrointestinal transit in patients with high output jejunostomy. Design: Placebo-controlled double-blind crossover study. Patients: Seven patients with a high jejeunostomy ou tput (2.5-91/24 h) after extensive bowel resection (residual jejunal l ength: 0-80 cm). Methods: Patients were studied on two test periods wh ich were identical except for the subcutaneous injection of octreotide 100 mug or placebo three times daily. During each test period, a soli d-liquid meal was given (830 kcal, 36 g fat, 6.9 g nitrogen) and stoma l effluent was collected over 10 h. Gastric emptying of solids and oro stomal transit time of liquids and solids were studied by adding two m arkers to the meal (polyethylene glycol 4000 and radio-opaque pellets, respectively). Results: Compared with placebo, octreotide significant ly reduced fluid losses (1572+/-390 versus 969+/-358 mg/10 h, P<0.001) and the sodium, potassium, chloride content (P<0.001) of jejunostomy effluent. Octreotide had no adverse effects on the positive balance of fat, nitrogen, calcium and magnesium, and slightly improved the energ y absorbed from the meal (P = 0.059). Orostomal transit time of liquid s and solids was markedly increased by octreotide (P<0.05). Conclusion s: Acute administration of octreotide can reduce fluid and electrolyte losses in patients with severe short bowel syndrome and jejunostomy w ithout reducing nutrient and mineral absorption.