Octreotide in refractory functional epigastric pain with nutritional impairment - an open study

Aim: To test the therapeutic efficacy of octreotide administered subcutaneo usly for the relief of chronic refractory epigastric pain severe enough to provoke nutritional impairment. Subjects and methods: Seventeen patients were enrolled in an open trial. Ep igastric pain had lasted from 1 to 8 years (median: 5 years), following ant i-reflux surgery in eight patients. Median weight loss was 10% (range 10-15 ). The initial dose of octreotide was 50 mu g b.d. adjusted during the foll ow-up visits which were scheduled for months 1, 3, 6, 8, 10, 12 and every 3 months. At each visit, overall symptomatic improvement, frequency and inte nsity of symptoms were checked on a 10-cm visual analogic scale. Results: At month 1, a progressive improvement of pain intensity was report ed in 15 of the 17 patients, while octreotide was a therapeutic failure in two. In four out of 15, the daily dose of octreotide was increased to 100 m u g b.d. In these 15 patients, median follow-up was 7 months (3-27). The sy mptomatic benefit was maintained in each patient at month 3, with a median weight gain of 3.5 kg.(2-5) An attempt to stop octreotide led to recurrence of symptoms in 2-3 days which were as intense as before the treatment. The 11 patients followed-up for at least 6 months reported persistent improvem ent of symptoms with octreotide and a median weight gain of 4 kg.(3-7) Four patients were followed up for more 11-27 months: octreotide was withdrawn gradually in two who remained asymptomatic. Six of the 17 patients experien ced minor side-effects, but none developed biliary sludge. Conclusions: This open study suggests that octreotide could be a promising alternative treatment when all others fail in refractory chronic functional epigastric pain severe enough to limit food intake and to induce nutrition al impairment. These results must be tested by a placebo-controlled study.