Effect of sequential erythromycin and octreotide on antroduodenal manometry.
BACKGROUND
In earlier studies, erythromycin stimulated but octreotide inhibited gastric antral contractions, as each drug induced phase 3-like episodes.


METHODS
To assess the effect of erythromycin pretreatment on octreotide-induced changes in antroduodenal motility, 16 patients were studied (mean age, 8.7 +/- 1.5 years, 8 male): 6 with severe gastroesophageal reflux, 4 with cyclic vomiting, 3 with gastroparesis, 2 with chronic intestinal pseudo-obstruction, and 1 with Crohn's disease and unexplained nausea and vomiting. After recording fasting antroduodenal motility for 3 hours, 1 mg/kg intravenous erythromycin was administered over 30 minutes. Sixty minutes after the erythromycin infusion, 0.5 microg/kg subcutaneous octreotide was administered, followed 1 hour later by a meal.


RESULTS
Phase 3 occurred spontaneously in 10 patients and after erythromycin in 12 patients. When administered after erythromycin, octreotide immediately induced phase 3s contractions in 15 patients, beginning in the antrum. In 7 children, some of the octreotide-induced phase 3s did not propagate. After the meal, antral contractions continued in all patients. The fed pattern was replaced in 14 patients by alternating phase 3 and phase 1 activities.


CONCLUSIONS
Pretreatment with erythromycin prevented octreotide-induced inhibition of antral contractions. Inhibition of antral contractions by octreotide may be mediated through either a direct or indirect suppression of motilin release, because antral contractions persist after pretreatment with the motilin receptor agonist erythromycin.
Di Lorenzo
C
C
Department of Pediatrics, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Lucanto
C
C
Flores
A F
AF
Idries
S
S
Hyman
P E
PE
D002648:Child; D003424:Crohn Disease / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004386:Duodenum / Q000503:physiopathology; D004917:Erythromycin / Q000008:administration & dosage*; D005215:Fasting; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005769:Gastrointestinal Motility / Q000187:drug effects*; D018589:Gastroparesis / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D009119:Muscle Contraction; D015282:Octreotide / Q000008:administration & dosage*; D010507:Periodicity; D011706:Pyloric Antrum / Q000503:physiopathology; D014839:Vomiting / Q000188:drug therapy / Q000503:physiopathology
D005765:Gastrointestinal Agents; D004917:Erythromycin; D015282:Octreotide