Farthing M J
Department of Gastroenterology, St Bartholomew's Hospital, London.
Gut. 1994;35(3 Suppl):S5-10. doi: 10.1136/gut.35.3_suppl.s5.
Persistent, refractory diarrhoea continues to be an important clinical problem. The mechanisms involved are associated with reduced intestinal absorption and increased intestinal secretion. Reduced intestinal absorption can result from small intestinal resection or from disorders in which there is damage to the small intestine. Motility disorders may also impair absorptive function. The rationale for using octreotide in refractory diarrhoea, intestinal motility disorders, and fistulae relates to its ability to promote intestinal absorption and inhibit gastric, pancreatic, and intestinal secretion. Several clinical studies in patients with short bowel syndrome have reported a reduction of intestinal output in patients taking octreotide compared with controls. Additionally, a number of studies have shown that octreotide improves secretory diarrhoea resulting from neuroendocrine tumours, intestinal infections in AIDS patients, and intestinal graft v host disease. Octreotide may be of use in patients suffering from intestinal motility disorders such as those associated with systemic sclerosis. Octreotide may also be of value in promoting closure of gastrointestinal and pancreatic fistulae.
持续性难治性腹泻仍然是一个重要的临床问题。其涉及的机制与肠道吸收减少和肠道分泌增加有关。肠道吸收减少可能源于小肠切除或小肠受损的疾病。动力障碍也可能损害吸收功能。在难治性腹泻、肠道动力障碍和瘘管中使用奥曲肽的理论依据与其促进肠道吸收以及抑制胃、胰腺和肠道分泌的能力有关。多项针对短肠综合征患者的临床研究报告称，与对照组相比，服用奥曲肽的患者肠道排出量减少。此外，多项研究表明，奥曲肽可改善神经内分泌肿瘤、艾滋病患者肠道感染以及肠道移植物抗宿主病所致的分泌性腹泻。奥曲肽可能对患有肠道动力障碍（如与系统性硬化症相关的动力障碍）的患者有用。奥曲肽在促进胃肠道和胰腺瘘管闭合方面可能也有价值。
