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Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction

  • Intestinal Disorders, Inflammatory Bowel Disease, Immunology, and Microbiology
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Abstract

Treatment of chronic intestinal pseudoobstruction with prokinetic agents has been disappointing. Our study was designed to determine if octreotide and erythromycin would provide sustained relief from nausea, abdominal pain, and bloating in pseudoobstruction. Using gastrointestinal manometry, quantitative parameters of the activity front of the migrating motor complex at baseline and after prokinetic therapy with erythromycin and octreotide were determined in 14 patients with intestinal pseudoobstruction who had nausea, abdominal pain, and bloating. Patients were treated with erythromycin and octreotide for 20–33 weeks. Octreotide increased the frequency, duration, and motility index of activity fronts (AFs) from 1.2±0.3 AFs/4hr, 2.7±0.7 min, and 85±23 min mm Hg to 4.1±0.8 AFs/4 hr, 5.5±0.7 min, and 152±24 min mm Hg, respectively (P<0.05). Antral activity was decreased from 63±14 to 23±8% by octreotide (P<0.05). Erythromycin induced antral activity; however, small intestinal motor activity was suppressed. While on erythromycin and octreotide, five patients had long-term improvement of nausea and abdominal pain. All responders had at least 5 AFs/4 hr induced by octreotide. We conclude that octreotide and erythromycin relieve abdominal pain and nausea in pseudoobstruction. Patients who have at least 5 AFs/4 hr after octreotide administration are most likely to clinically respond.

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Author notes

  1. G. Nicholas Verne MD

    Present address: Digestive Disease Center, Medical University of South Carolina, 171 Ashley Ave., 29425-2220, Charleston, South Carolina

Authors and Affiliations

  1. Gainesville Veterans Affairs Medical Center, and Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, 32610, Gainesville, Florida

    G. Nicholas Verne MD, Ervin Y. Eaker MD, Ester Hardy &  Charles A. Sninsky MD

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  3. Ester Hardy
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Verne, G.N., Eaker, E.Y., Hardy, E. et al. Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction. Digest Dis Sci 40, 1892–1901 (1995). https://doi.org/10.1007/BF02208652

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  • DOI: https://doi.org/10.1007/BF02208652

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