The present study evaluates the acute and chronic use of a long-acting
somatostatin analog,
octreotide acetate, in the treatment of patients with severe postgastrectomy
dumping syndrome. In the acute phase, 10 patients with severe dumping were studied over 2 consecutive days before and for 3 hours after the ingestion of a 'dumping breakfast' in a randomized double-blind fashion. On one day
octreotide (100 micrograms) was given subcutaneously 30 minutes before the test meal and on the other day an equal volume of vehicle was injected. An additional group of six postgastrectomy patients without dumping were studied in a similar fashion and these acted as controls. During placebo treatment the test meal resulted in an immediate increase (p less than 0.01) in the pulse rate and in plasma levels of
glucose,
glucagon,
pancreatic polypeptide,
neurotensin, and
insulin. Similar changes were seen in the control group with respect to placebo; however
glucagon and
neurotensin (p less than 0.05) did not show the same magnitude of increase as seen with placebo. Treatment with
octreotide acetate prevented the development of both vasomotor and gastrointestinal symptoms and completely ablated all of the above responses in plasma
peptides. These changes were associated with complete ablation of
diarrhea (p less than 0.001). Pretreatment with
octreotide acetate completely suppressed the rise in plasma
insulin response to the meal and this ablated the late
hypoglycemia of dumping. Treatment with
octreotide acetate resulted in delayed gastric emptying and transit time (578 +/- 244 minutes) versus 76 +/- 23 minutes with placebo and 125 +/- 36 minutes in controls (p less than 0.05). Chronic daily treatment with
octreotide acetate resulted in minimal side effects. These patients demonstrated a stable fasting plasma
glucose, normal liver function tests, and an average
weight gain of 11% during a 12-month period. In addition most patients were able to resume employment. The long-acting
somatostatin analog,
octreotide acetate, is highly effective in preventing the development of symptoms of severe
dumping syndrome, both vasomotor and gastrointestinal.