Octreotide reduces abdominal and vasomotor symptoms in
dumping syndrome by unknown mechanisms. Effects of
octreotide (50 microgram) on symptoms, hemodynamic parameters and plasma
glucose and
insulin levels after
glucose meals were tested in double-blind, placebo-controlled, crossover fashion in eight patients with
dumping syndrome. Gastric scintigraphy tested whether
octreotide reduces symptoms by slowing gastric emptying.
Octreotide reduced
diarrhea,
lightheadedness and palpitations after 75 g of
glucose, compared with placebo (P < .001). Orthostatic pulse increases after
glucose decreased from 36 +/- 6 beats/min after placebo to 9 +/- 5 beats/min after
octreotide (P < .05), and standing blood pressure decreases after
glucose were abolished (P < .05), but
octreotide had no effect on increase in hematocrit or plasma osmolarity after
glucose. Late
hypoglycemia was prevented by
octreotide, and peak fed
insulin levels were reduced from 87 +/- 15 to 26 +/- 9 microU/ml after
octreotide (P < .05). Times to maximal plasma
glucose levels after meals were prolonged from 28 +/- 4 to 78 +/- 6 min after
octreotide (P < .05).
Octreotide had no effect on gastric emptying of liquids or solids. In conclusion, amelioration of dumping symptoms by
octreotide is associated with reduced
orthostasis, which is not a consequence of prevention of hemoconcentration. Prevention of late
hypoglycemia may be due to blunted
insulin release.
Octreotide does not reverse rapid gastric emptying, indicating a limited role for this purported mechanism of action.