EFFECTS OF OCTREOTIDE ON MANOMETRIC VARIABLES IN PATIENTS WITH NEUROPATHIC ABNORMALITIES OF THE SMALL-BOWEL

At present, there are few therapeutic options in patients with chronic intestinal dysmotilities. Octreotide, a long-acting somatostatin anal og, has recently been shown to be a potentially useful drug in this se tting, being able to start activity fronts (AF) in the small bowel in both healthy subjects and patients with intestinal motor disorders. We studied the effects of octreotide on manometric variables in 10 patie nts with chronic upper gastrointestinal symptoms and an intrinsic neur opathic disorder of the small intestine. Gastrointestinal manometry wa s carried out for 6 hr during fasting and 2 hr after a standard 605-kc al mixed meal. Thereafter octreotide, 50 mu g subcutaneously was admin istered and the recording session continued for a further hour. Analys is of the tracings during fasting showed that 44% of the AF were abnor mal; octreotide significantly increased the hourly number of AF (2 +/- 0.26 vs 0.67 +/- 0.14, P < 0.0001) and their duration (8.33 +/- 1.3 v s 6.12 +/- 0.34 min, P < 0.05) with respect to the baseline (fasting) period, and the propagation velocity also 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 octreot ide was always abnormally propagated. An almost complete inhibition of small bowel postprandial contractile activity was observed in 80% of patients, and the remaining 20% showed decreases. In three subjects, o ctreotide injection evoked the appearance of pylorospasm. From these r esults we conclude that octreotide could be of some benefit in patient s with neuropathic disorders of the small bowel, although it remains t o be established whether it is most useful in patients with more sever e conditions, characterized by the complete absence of AF. The appeara nce of pylorospasm may contribute to the delayed gastric emptying obse rved after the drug is administered.