Effect of Octreotide on Colonic Motility in Pediatric Patients With Chronic Recalcitrant Constipation

Abstract

Objective: To study the effect of octreotide on colonic motility in pediatric patients with recalcitrant chronic constipation/encopresis and other suspected colonic motility disorders.Methods: This was a non-randomized, single center, open label, prospective study evaluating the effect of a single subcutaneous dose of octreotide on colonic motility Results: Thirteen patients (5 male) were enrolled in the study. The age range was 4.6-16.2 years. Eleven patients (84%) had normal colonic manometry and two patients (16%) had colonic neuropathy. Motility Index (MI) (mm Hg) for the 15 minutes before and after octreotide infusion was 6.03 ± 1.26 (95% CI, 5.35-6.72), and 5.32 ± 1.66 (95% CI, 4.42-6.23) respectively with p-value of 0.08. MI for the 30 minutes before and after octreotide infusion was 6.89 ± 1.37 (95% CI, 6.14-7.64) and 6.71 ± 1.47 (95% CI, 5.91-7.52) respectively with p-value of 0.55. MI for the 45 minutes before and after octreotide infusion was 7.73 ± 1.32 (95% CI, 7.01-8.45) and 7.53 ± 1.38 (95% CI, respectively with p-value of 0.8. Conclusion: Our study showed that administration of octreotide resulted in no significant changes in colonic motility index in pediatric patients with chronic recalcitrant constipation.

Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry

“…For instance, the maximum dose ranges between 5 and 10 mg and only a single intraluminal stimulation is usually suggested with only few studies reporting the use of either two doses or a single higher dose. 7,9,[15][16][17][18][19][20][21] In the present study, the additional higher dose of bisacodyl (0.4 mg/kg up to a maximum of 20 mg) significantly increased the number of HAPCs throughout the entire colon, improved the propagation of HAPCs toward the distal colon, and sharpened the morphology of pressure waves within HAPCs. This suggests that this higher dose may be more effective compared with lower doses in assessing the residual function of colonic motor activity and in discriminating between those patients with normal colonic motor activity from those with localized segmental abnormalities.…”

“…To date, there is a still considerable inconsistency regarding the dose of bisacodyl that should infused intraluminally during manometric recording. For instance, the maximum dose ranges between 5 and 10 mg and only a single intraluminal stimulation is usually suggested with only few studies reporting the use of either two doses or a single higher dose . In the present study, the additional higher dose of bisacodyl (0.4 mg/kg up to a maximum of 20 mg) significantly increased the number of HAPCs throughout the entire colon, improved the propagation of HAPCs toward the distal colon, and sharpened the morphology of pressure waves within HAPCs.…”

“…14 During the manometric recording, the bisacodyl dose appears to be standardized at 0.2 mg/kg; conversely, the suggested maximum dose is extremely variable ranging between 5 mg and 10 mg. 7,9,[15][16][17][18][19] To the best of our knowledge, provocation with only a single intraluminal dose is advocated with scarce data regarding either the use of repeated or higher doses. 20,21 In our center a dual sequential incremental dose regime was instituted in 2011 given clinical concerns over limited response to a single dose (0.2 mg/kg) regime, which may provide insufficient clarity to inform further management decisions including surgery and evidence that higher doses may be used to stimulate colonic contractions. 22 Therefore, in this retrospective study we aimed to explore whether an additional higher 'double dose' of bisacodyl increases the diagnostic yield and accuracy of CM and, theoretically, impact on decision making in the clinical management of patients with slow transit constipation (STC).…”

First translational consensus on terminology and definitions of colonic motility in animals and humans studied by manometric and other techniques

“…They typically occur following meals and upon waking, and can be induced by bisacodyl 128 . Octreotide and erythromycin do not induce HAPCs [129][130][131] .…”

Colonic Transit Time and Gut Peptides in Adult Patients with Slow and Normal Colonic Transit Constipation

“…Finally, as regards somatostatin no differences were present in constipated patients according to the colon transit time and HC. Actually, long lasting somatostatin analogues (octreotide, lanreotide) seem to be limited to the treatment of neuroendocrine tumours and adjuvant treatment of oesophageal variceal bleeding and pancreatic fistulas [ 45 ], and some authors found that octreotide was not able to affect colonic motility in paediatric patients with functional constipation [ 46 ].…”