Reduction of the effluent volume in high-output ileostomy patients by a somatostatin analogue, SMS 201-995

Abstract

Twelve ileostomy patients were given subcutaneous SMS 201-995 therapy (100 micrograms t.d.s. for 5 days) in a randomized placebo-controlled trial. All patients had ileostomies constructed 60 cm proximal to the terminal ileum (proximal ileostomy) following restorative proctocolectomy. SMS 201-995 reduced the daily ileostomy output from 997 +/- 52 g to 736 +/- 28 g, P < 0.05, along with a decrease in daily sodium and chloride excretion (sodium: 92.60 +/- 8.51 to 75.22 +/- 8.64 mEq, chloride: 143.46 +/- 8.54 to 113.60 +/- 15.84 mEq; both P < 0.05). There were no significant changes in the plasma levels of glucagon, C peptide, insulin, renin or aldosterone with SMS 201-995 therapy. Patients developed no severe side effects and reported easier management of the ileostomy and a reduction in thirst. Our results suggest a possible clinical role for SMS 201-995 in the management of proximal ileostomy.

Guidelines for management of patients with a short bowel

“…[111][112][113][114][115][116][117][118][119] The greatest reductions in intestinal output are in those with a net secretory output, and the volume of parenteral supplements needed may be reduced. [115][116][117][118][119] The reduction in sodium output parallels that of intestinal output 111-119 while magnesium balance is unchanged.…”

Management of patients with a short bowel

“…Octreotide has a serum halflife of 90 minutes so is given as regular (two or three time's daily) subcutaneous injections before food. Several studies in adults have shown octreotide to reduce ileostomy diarrhoea and large volume jejunostomy outputs [100,[107][108][109][110][111][112][113][114] . The greatest reductions in intestinal output have occurred in net "secretors", and many patients have been able to reduce the volume of parenteral supplements needed [110,114] .…”

“…The greatest reductions in intestinal output have occurred in net "secretors", and many patients have been able to reduce the volume of parenteral supplements needed [110,114] . All studies have shown a reduction in sodium output, which parallels that of the intestinal output [100,[107][108][109][110][111][112][113][114] . Magnesium balance has not been changed by octreotide [107,112] .…”

Causes and management of a high-output stoma

“…Management of a HOS includes the identification and treatment of any cause for the high output, reduction and replacement of water and electrolyte losses [initially via the intravenous (iv) route], oral hypotonic fluid restriction with the use of glucose ⁄ electrolyte solution [9,11,12], anti diarrhoeal [13][14][15] and anti secretory medication [9,[16][17][18][19][20][21][22][23], nutritional support, wound care and psychological support.…”