Treatment of small intestinal disease in systemic sclerosis with octreotide: a prospective study in seven patients.
BACKGROUND
Symptoms associated with small intestinal involvement in patients with systemic sclerosis (SSc) are usually severe and resistant to treatment.


OBJECTIVE
To assess the safety and efficacy of octreotide in refractory small intestinal disease complicating SSc.


METHODS
Seven female patients (aged from 37 to 64 years old) with SSc were included in the study. All of them had symptoms compatible with small bowel pathology, nonresponding to several prokinetic agents. The patients received either subcutaneous octreotide, 0.1 mg twice daily, or intramuscular octreotide LAR (long-acting-release), 20 mg/mo. Symptom severity was assessed at baseline and at various follow-up points in a scale of 0-3, for each symptom. Significant gastrointestinal pathology was excluded by gastroscopy, colonoscopy, and small bowel enemas before octreotide administration.


RESULTS
All patients responded to octreotide, and a significant reduction from symptom severity at baseline (mean +/- SD: 2.9 +/- 1.1) was noted even in the first following month (1.3 +/- 0.5, P = 0.0006). A significant disturbance of defecation in 2 patients improved dramatically. Short relapses were noticed in patients who were initially treated with subcutaneous octreotide. These patients were subsequently treated with octreotide LAR, resulting in an overall symptom reduction at 6 months (0.7 +/- 0.5, P = 0.003), which was sustained during follow-up (median follow-up: 14.4 months). No side effects were noted.


CONCLUSIONS
These results suggest that long-term treatment with octreotide LAR may be a safe and effective approach for treatment of small intestinal disease in patients with SSc.
Nikou
George C
GC
Section of Gastroenterology, 1st Department of Propaedeutic Internal Medicine, Medical School, University of Athens, Greece.
Toumpanakis
Christos
C
Katsiari
Christina
C
Charalambopoulos
Dionisios
D
Sfikakis
Petros P
PP
D015746:Abdominal Pain / Q000188:drug therapy / Q000503:physiopathology; D000328:Adult; D003672:Defecation / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D007421:Intestine, Small / Q000503:physiopathology*; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000503:physiopathology; D015282:Octreotide / Q000627:therapeutic use*; D011446:Prospective Studies; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy / Q000503:physiopathology
D005765:Gastrointestinal Agents; D015282:Octreotide