Octreotide in chemotherapy induced diarrhoea in colorectal cancer: a review article.

BACKGROUND: Chemotherapy-induced diarrhoea (CID) is well known in cancer management. The risk is greater when the primary cancer is colorectal. This article aims towards assessing the role of octreotide in CID through an extensive literature search. METHODS: After searching through PUBMED, MEDLINE and the Cochrane library, only those studies which were published over the last 20 years in English and where at least the majority of the cohort were colorectal patients, were included. Two randomized trials, four non-randomized studies and two case-series publications were thus considered. RESULTS: It was seen in both the randomized studies, that octreotide had much better outcome as compared to loperamide in treating severe CID. Among 88 patients from the non-randomized studies with severe CID, the primary cancer was colorectal in 79 patients. 61 patients had drug-resistant CID. Within a maximum of 96 hours, octreotide reduced CID by > or = 2 grades in 91% of 88 patients and in 88.52% patients with drug-resistant CID. CONCLUSION: Octreotide is effective in treating severe CID, resistant to other modes of treatment. It is associated with a few minor adverse effects. Though expensive, octreotide could be considered as first line medication in CID of grades 3 or above. Its use in lower grades of CID would not be cost effective.

Effect of ileal infusion of lipid on jejunal motor patterns after a nutrient and nonnutrient meal.

To investigate how ileal lipid delays small bowel transit, pressure activity was recorded at multiple sites in the human small intestine during ileal infusion of either lipid or saline. Initial studies showed that ileal lipid reduced the contraction rate in the jejunum but not in the duodenum or ileum. The effect of ileal lipid was further investigated by recording pressures at seven sites in the jejunum after ingestion of either a nutrient or a nonnutrient meal. The nutrient meal induced an irregular motility pattern; ileal lipid significantly reduced the contraction rate, the percentage of contractions involved in propagated events, the mean length of propagation, and the propagation index. The nonnutrient meal induced a pattern containing discrete clusters of contractions. Ileal lipid significantly reduced the occurrence of contraction clusters and the mean length of propagation. Thus, although the delay in small bowel transit observed during ileal infusion of lipid can be explained by reductions in the rate and the degree of propagation of jejunal contractions, the mechanism varies according to the type of meal.

The effect of guar gum on the distribution of a radiolabelled meal in the gastrointestinal tract of the rat.

1. The effect of addition of guar gum (5 and 10 g/l) to a radiolabelled, homogenized, baked-bean test meal on the distribution of that meal in the gastrointestinal tract was investigated in groups of male rats killed at 25, 50, 100, 200, 300 and 400 min after gavage. 2. Addition of 5 and 10 g guar gum/l significantly increased the proportion of the meal remaining in the stomach at 25 and 50 min after gavage (P less than 0.01). 3. The heads of the control meal and meals containing guar gum reached the distal intestine within 25 min after gavage but radioactivity was not observed in the caecum until 100 min after administration of each of the meals. Addition of guar gum (5 and 10 g/l) delayed caecal filling even though the head of each meal reached the caecum at the same time after gavage. 4. The geometric centres of guar-gum-containing meals were proximal to that of the control meal at all times after gavage. 5. The observed delay in the passage of a guar-gum-containing meal through the stomach and small intestine is probably due to the viscous nature of the meal resisting the propulsive and mixing effects of the gastrointestinal contractions, thereby reducing access of the glucose to the absorptive epithelium. This could contribute to the observed reductions in postprandial glycaemia seen in previous studies after incorporating guar gum into a meal.