title: Utility of Octreotide in Advancing Enteral Feeds in Children with Chronic Intestinal Pseudo-Obstruction.
abstract: OBJECTIVE
  Chronic intestinal pseudo-obstruction (CIPO) is a challenging disorder with high morbidity and mortality due to limited effective therapies that improve enteral tolerance. We aimed to present our experience using octreotide in children with CIPO and evaluate factors predicting therapy response.
  
  
  METHODS
  The study population included total parenteral nutrition (TPN)-dependent children with CIPO receiving octreotide at a tertiary care center. Octreotide response was defined as an enteral feeding increase of ≥10 cc/kg/day.
  
  
  RESULTS
  A total of 16 children were included (median age 5 years, range 1-18; 88 % female). We observed an overall feed increase in 11/16 (69 %) subjects and 7/16 (44 %) were considered responders: three tolerated >65 cc/kg/day (discontinued TPN), one tolerated >30 cc/kg/day (decreased TPN) and three patients tolerated 10-12 cc/kg/day. We found an association between therapeutic octreotide response and both the presence of octreotide-induced intestinal phase III of the migrating motor complex (MMC) as well as a higher median increase in intestinal motility index after octreotide challenge during the antroduodenal manometry (p = 0.03 and <0.01, respectively). We did not find an association between octreotide response and age, presence of ileostomy, and colonic manometry testing parameters. Side effects were observed in four patients: an allergic reaction and hyperglycemia requiring octreotide discontinuation, hypertension that responded to dose reduction, and cholecystitis (gallstones) with octreotide successfully restarted after cholecystectomy.
  
  
  CONCLUSIONS
  Octreotide is safe and effective in improving enteral tolerance in TPN-dependent children with CIPO and the antroduodenal manometry may be helpful in predicting octreotide response. Prospective studies are needed to evaluate the safety and efficacy of octreotide in children with CIPO.
authors: Division of Gastroenterology, Department of Medicine, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.|Division of Gastroenterology, Seattle Children's Hospital, Seattle, WA, USA.
authors: Lusine
authors: L
authors: Ambartsumyan
authors: Division of Gastroenterology, Department of Medicine, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
authors: Alejandro
authors: A
authors: Flores
authors: Division of Gastroenterology, Department of Medicine, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
authors: Samuel
authors: S
authors: Nurko
authors: Division of Gastroenterology, Department of Medicine, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. Leonel.rodriguez@childrens.harvard.edu.
authors: Leonel
authors: http://orcid.org/0000-0002-7128-6048
authors: L
authors: Rodriguez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007223:Infant; D007418:Intestinal Pseudo-Obstruction / Q000628:therapy*; D007422:Intestines / Q000503:physiopathology; D008297:Male; D008365:Manometry; D015282:Octreotide / Q000627:therapeutic use*; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies
chemical_list: D015282:Octreotide