From the Guidelines
Octreotide, a somatostatin analogue, can decrease gastric secretions, as evidenced by its ability to reduce jejunostomy output and ileostomy diarrhea in patients with a short bowel. This is supported by a study published in the journal Gut in 2006 1, which found that octreotide, at a dose of 50 mg subcutaneously twice daily, was as effective as other antisecretory drugs, such as H2 antagonists or proton pump inhibitors, in reducing the volume of stomal output. The mechanism of action of octreotide involves binding to somatostatin receptors throughout the gastrointestinal tract, leading to decreased release of secretagogues and direct inhibition of secretory cells.
Some key points to consider when using octreotide to decrease gastric secretions include:
- The dose and administration route, which can vary depending on the specific clinical scenario, but is typically 50-200 mcg subcutaneously two to three times daily or as a continuous intravenous infusion at 25-50 mcg/hour
- The potential side effects, including nausea, abdominal discomfort, and potential gallstone formation with long-term use
- The need to monitor blood glucose levels, as octreotide can affect insulin and glucagon release
- The potential benefits of using octreotide in patients with a short bowel, including reduced ileostomy diarrhea and large volume jejunostomy output, and decreased need for parenteral supplements.
Overall, octreotide is a valuable therapeutic option for reducing gastric secretions in certain clinical scenarios, and its use should be considered in patients who may benefit from decreased gastrointestinal secretions, such as those with variceal bleeding, secretory diarrhea, pancreatic fistulas, and certain neuroendocrine tumors, as supported by the study published in Gut in 2006 1.
From the FDA Drug Label
Octreotide acetate injection exerts pharmacologic actions similar to the natural hormone, somatostatin. It is an even more potent inhibitor of growth hormone (GH), glucagon, and insulin than somatostatin Like somatostatin, it also suppresses luteinizing hormone (LH) response to gonadotropin releasing hormone (GnRH), decreases splanchnic blood flow, and inhibits release of serotonin, gastrin, vasoactive intestinal peptide (VIP), secretin, motilin, and pancreatic polypeptide
Octreotide can decrease gastric secretions by inhibiting the release of gastrin, a hormone that stimulates gastric acid secretion. 2
From the Research
Gastric Secretions and Octreotide
- Octreotide, a somatostatin analogue, has been shown to reduce gastric acid secretion in various studies 3, 4, 5.
- The mechanism of action of octreotide involves suppressing the release of peptide hormones, including those that stimulate gastric acid secretion 3.
- In patients with Zollinger-Ellison syndrome and antral G-cell hyperfunction, three months of octreotide treatment decreased gastric acid secretion and argyrophil cell density 5.
- Octreotide has also been shown to reduce splanchnic blood flow, GI motility, and pancreatic exocrine function, which can contribute to its effect on gastric secretions 3.
Gastric Emptying and Octreotide
- The effect of octreotide on gastric emptying is more complex, with some studies showing a delay in gastric emptying 6, 7 and others showing an acceleration 6.
- In healthy volunteers, octreotide has been shown to delay the gastric emptying of solids and liquids 7.
- However, in patients undergoing pancreatic surgery, octreotide has been shown to accelerate gastric emptying, possibly by shortening the lag time and suppressing postprandial cholecystokinin release 6.
Clinical Implications
- The use of octreotide to decrease gastric secretions may be beneficial in certain clinical conditions, such as Zollinger-Ellison syndrome and antral G-cell hyperfunction 5.
- However, the effect of octreotide on gastric emptying should be considered when using this medication in clinical practice, as it may have varying effects depending on the patient population and clinical context 6, 7.