ROLE OF SOMATOSTATIN AND ITS ANALOGS IN THE TREATMENT OF ACUTE AND CHRONIC-PANCREATITIS

Acute pancreatitis is caused by the activation of digestive enzymes in the pancreas and a possible treatment, therefore, is the inhibition o f enzyme secretion. This approach is somewhat controversial, however, as it is not clear whether pancreatic secretion continues to occur dur ing the course of acute pancreatitis. Animal studies show an appreciab le reduction of secretion in the inflamed pancreas, but studies in hum ans are not conclusive. The use of somatostatin or its analogue, octre otide, has been investigated in several clinical studies. A meta analy sis of six individual studies in which somatostatin was given for acut e pancreatitis showed that somatostatin significantly reduces mortalit y. A trial in patients with moderate to severe acute pancreatitis show ed a lower rate (although not statistically significant) of complicati ons in patients treated with 3 X 200 and 3 X 500 mu g/day octreotide, compared with controls and patients receiving a lower dose of octreoti de. A further study showed a significant reduction in patient controll ed analgesics in patients treated with octreotide compared with contro ls. Pain is the important clinical symptom of chronic pancreatitis, po ssibly resulting fi om an increased intraductal pressure during secret ion. The effect on pain of the inhibition of pancreatic secretion by o ctreotide has been investigated in two studies. One showed no signific ant reduction in pain after treatment with octreotide for three days. In the other, in which octreotide was used for three weeks, significan tly less pain and analgesic use was recorded during octreotide treatme nt than during placebo. The most common complication of chronic pancre atitis is the formation of pseudocysts. There is some evidence that oc treotide may be useful in their treatment.