Control of dumping symptoms by somatostatin analogue in patients after gastric surgery
J. L. Gray, H. T. Debas and S. J. Mulvihill
Department of Surgery, University of California, San Francisco.
Octreotide acetate is a long-acting analogue of the naturally occurring
inhibitory gastrointestinal peptide, somatostatin. We tested the efficacy
of octreotide in controlling the symptoms of dumping syndrome in response
to a provocative meal in a randomized, double-blinded, crossover trial in
nine severely affected patients. Pretreatment with octreotide acetate (100
micrograms injected subcutaneously) reduced postprandial dumping symptoms
from a mean +/- SEM score of 15.7 +/- 1.6 (placebo treatment day) to 4.6
+/- 1.7. With placebo treatment, all nine patients became symptomatic in
response to the meal, whereas with octreotide treatment, symptoms occurred
in only two of nine patients. Similarly, all placebo-treated patients
showed a postprandial increase in pulse rate to a mean +/- SEM of 105 +/- 6
beats per minute, whereas only one of nine octreotide-treated patients
showed an increase in pulse rate (mean +/- SEM, 80 +/- 3 beats per minute).
These differences were also statistically significant. While no significant
changes were observed in postprandial hematocrit values or osmolality
between placebo and octreotide treatments, octreotide prevented
hypoglycemia in four affected patients and significantly inhibited insulin
release. We conclude that octreotide is a useful tool in the treatment of
patients with severe, refractory dumping syndrome.
