Edmunds M C, Chen J D, Soykan I, Lin Z, McCallum R W
Department of Medicine, University of Virginia Health Sciences Center, USA.
Aliment Pharmacol Ther. 1998 Feb;12(2):167-74. doi: 10.1046/j.1365-2036.1998.00289.x.
Octreotide has been shown to have effects on gastric and small bowel motility with implications for its role in treating patients with upper gastrointestinal dysmotility syndromes. Our aim was to investigate the effect of octreotide on antral and small bowel motility in patients with gastroparesis.
Upper gastrointestinal manometry was carried out continuously for a period of 30 h in 11 patients with gastroparesis. The spontaneous migrating motor complex (MMC) in the fasting state and octreotide-induced MMCs were characterized and compared with regard to site of origin, duration of phase III, amplitude of phase III and propagation velocity of the MMC along the gut. The 2-h postprandial motility index was compared after a control meal as well as after a 100 microg octreotide administration.
In all 11 gastroparetic patients, octreotide induced a phase III-like activity front within minutes after administration and this primarily originated in the small bowel (86% of activity fronts compared with 32% of fronts originating in the small bowel prior to octreotide administration (P < 0.004)). Gastric initiation of these activity fronts dramatically decreased after octreotide administration, occurring in 68% of activity fronts prior to octreotide administration and 14% of occasions after octreotide injection (P < 0.05). The postprandial antral motility index was markedly reduced after octreotide administration (11.33 +/- 0.39 vs. 7.96 +/- 0.76, P < 0.0003) and octreotide re-established a motility pattern during the postprandial period that was similar to that normally seen in the interdigestive state. The octreotide-induced phase III activity fronts appeared at a higher frequency and had a higher propagative velocity compared to the spontaneous phase III fronts in the fasting state (9.27 +/- 0.82 vs. 5.56 +/- 0.81 cm/min, P < 0.05).
We conclude that octreotide's marked inhibitory effect on antral contractility may serve to worsen clinical symptoms in patients with gastroparesis and therefore this agent should not be given in the periprandial period. Those gastroparetic patients with associated small bowel dysmotility and diarrhoea from bacterial overgrowth may benefit from the nocturnal administration of octreotide because of its stimulatory effect of phase III MMC activity as well as its known inhibitory effect on small bowel secretions.
已表明奥曲肽对胃和小肠动力有影响，这与其在治疗上消化道动力障碍综合征患者中的作用相关。我们的目的是研究奥曲肽对胃轻瘫患者胃窦和小肠动力的影响。
对11例胃轻瘫患者连续进行30小时的上消化道测压。对空腹状态下的自发移行性运动复合波（MMC）和奥曲肽诱导的MMC进行特征分析，并比较其起源部位、Ⅲ期持续时间、Ⅲ期振幅以及MMC沿肠道的传播速度。在对照餐以及给予100微克奥曲肽后，比较餐后2小时的动力指数。
在所有11例胃轻瘫患者中，奥曲肽给药后数分钟内诱导出类似Ⅲ期的活动前沿，且主要起源于小肠（86%的活动前沿，而奥曲肽给药前起源于小肠的前沿为32%（P<0.004））。奥曲肽给药后，这些活动前沿的胃起源显著减少，奥曲肽给药前68%的活动前沿起源于胃，奥曲肽注射后为14%（P<0.05）。奥曲肽给药后餐后胃窦动力指数显著降低（11.33±0.39对7.96±0.76，P<0.0003），且奥曲肽在餐后期间重新建立了一种与消化间期通常所见相似的动力模式。与空腹状态下的自发Ⅲ期前沿相比，奥曲肽诱导的Ⅲ期活动前沿出现频率更高，传播速度更快（9.27±0.82对5.56±0.81厘米/分钟，P<0.05）。
我们得出结论，奥曲肽对胃窦收缩力的显著抑制作用可能会加重胃轻瘫患者的临床症状，因此该药物不应在进餐前后给予。那些伴有小肠动力障碍和细菌过度生长导致腹泻的胃轻瘫患者，可能因奥曲肽对Ⅲ期MMC活动的刺激作用及其对小肠分泌的已知抑制作用而受益于夜间给予奥曲肽。
