The Role of Octreotide in Gastroparesis

Abstract

Introduction: Gastroparesis is characterized by disordered gastric emptying in the absence of mechanical obstruction. Available therapies for gastroparesis are limited in options and efficacy. The prokinetic agents used most often to improve gastric motility include dopamine-2 receptor antagonists, motilin agonists, and serotonin receptor agonists. Octreotide is a long-acting somatostatin analogue which can be used to modulate gastrointestinal function in children with dysmotility. Octreotide is underutilized as an option for the treatment of gastroparesis. Here we present 2 patients with gastroparesis who were successfully treated with octreotide subcutaneous or parenteral injections. Case Reports: An 18-year-old female with gastroparesis with multiple episodes of nausea and vomiting and weight loss was admitted for dehydration. She had normal upper GI series, endoscopy, and ultrasound. She had delayed gastric emptying while on metoclopramide and erythromycin. She was subsequently started on octreotide 100 mcg (2 mcg/kg/dose) 3 times a day with resolution of symptoms and improved gastric emptying. The second patient was a 13-year-old male with complicated medical history including GERD, status post gastrostomy and Nissen fundoplication as an infant, vomiting, failure to thrive, anxiety, and constipation. He presented with severe nausea and weight loss. His gastric emptying scan showed moderate delay. While on prokinetic agents his symptoms persisted and he required total parenteral nutrition (TPN) to maintain weight. Antroduodenal manometry revealed neurogenic dysmotility. He was started on octreotide injections 100 mcg (2 mcg/kg/dose) twice a day through his central line. Subsequently, he was weaned off TPN and started tolerating enteral nutrition and transitioned to oral feeds. Discussion: Despite the reported inhibitory effect of octreotide on postprandial gastric motility, we report successful treatment of 2 patients with octreotide. We hypothesize that fundic relaxation and modification of duodenal motility by induction of migrating motor complex phase III activity can explain the symptomatic improvement in our patients. Octreotide should be considered as an alternative agent in prokinetic resistant gastroparesis.