Octreotide May Be Effective in Treatment of Nonconstipated IBS

May 24, 2005

May 24, 2005 (Chicago) — Octreotide reduces abdominal complaints and improves stool consistency, suggesting that it may be beneficial in nonconstipated irritable bowel syndrome (IBS), according to findings presented here at Digestive Disease Week 2005.

The study examined the effect of a slow-release preparation of octreotide (Sandostatine LAR) on rectal sensitivity and symptoms in nonconstipated IBS patients. Previous research by Hasler and colleagues published in the March 1994 issue of the Journal of Pharmacology and Experimental Therapeutics determined that acute administration of octreotide inhibits afferent responses to rectal distension and possesses an antihyperalgesic effect in IBS, according the findings of Schwetz and colleagues in the January 2004 issue of Alimentary Pharmacology & Therapeutics. It was unknown if prolonged octreotide treatment would improve gastrointestinal tract symptoms and reduce visceral sensitivity. In fact, the eight-week treatment with octreotide compared with placebo did significantly increase patients' threshold for first sensation.

The randomized, double-blind, placebo-controlled, parallel group study involved 42 nonconstipated IBS patients from ages 19 to 63 years, including 20 females. Patients received 20 mg of octreotide daily. Each underwent a barostat study before and after the eight-week treatment to assess rectal sensitivity, using an intermittent, pressure-controlled, and a slow ramp volume-controlled distention protocol.

"The most important outcome of the study was the effects of the slow release of octreotide compared with an acute experience," Sjoerd Kuiken, MD, investigator of the study, told Medscape. "In its current form, it is not a safe drug. Patients have to be screened for gallstones every six months. It is only for treating severe and disabling cases of nonconstipated IBS now because of the adverse effects. Other data still have to be analyzed."

Octreotide has the additional benefits of slowing small bowel transit, inhibiting intraluminal secretion, and promoting absorption. The patients who received octreotide reported a 36% ± 2% effect on global relief, while those taking placebo reported a 27% ± 3% effect. Octreotide also improved stool consistency compared with placebo, with 49% ± 3% of patients having loose and watery stools vs 64% ± 2% in placebo (P < .01). However, abdominal pain and defecation frequency were not affected.

Novartis Pharma B.V. Arnhem provided grant and research support.

DDW 2005: Abstract 624. Presented May 17, 2005.

Reviewed by Jacqueline A. Hart, MD


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