Little Leakers
Somatostatin or Octrotide has numerous physiological effects:
It inhibits secretion of many hormones, such as gastrin, cholecystokinin, glucagon, growth hormone, insulin, secretin,
pancreatic polypeptide, TSH, and vasoactive intestinal peptide.  

1.  It reduces secretion of fluids by the intestine and pancreas.  
2.  It reduces gastrointestinal motility and inhibits contraction of the gallbladder.
3.  It inhibits the secretion of certain hormones from the anterior pituitary.

The Food and Drug Administration (FDA) has approved the usage of a salt form of this peptide, octreotide acetate, as
an injectable depot formulation for the treatment of acromegaly, the treatment of diarrhea and flushing episodes
associated with carcinoid syndrome, and treatment of diarrhea in patients with vasoactive intestinal peptide-secreting
tumors (VIPomas).

Octreotide has also been used off-label for the treatment of severe, refractory diarrhea from other causes. It is used in
toxicology for the treatment of prolonged recurrent hypoglycemia after sulfonylurea overdose.

In patients with suspected esophageal varices, octreotide can be given to help decrease bleeding.

(2004)in Katzung, Bertram G. (ed.): Basic and Clinical Pharmacology. Stamford, Conn: Lange Medical Books/McGraw Hill.
Treatment with octreotide has also been helpful in select cases of PIL. It is felt that octreotide reduces the secretion
of bile into, and chyle from, the intestine by binding to somatostatin receptors in the intestinal lymphatics and
intestinal vasculature. Decrease in bile flow leads to diminution of fat emulsification in the intestinal lumen, and thus
decreases the absorption of dietary triglycerides into the already overloaded lacteals. Octreotide may also reduce
protein losses by decreasing intestinal motility and secretion. As with antiplasmin therapy, however, octreotide fails to
induce an increase in lymphocyte counts, again suggesting that the underlying lymphatic disorder is unaffected.

Primary Intestinal Lymphangiectasia
 Charles M. Bliss, MD and Paul C. Schroy III, MD, MPH
The aim of octreotide therapy in PIL are to decrease hepatic secretion of bile, intestinal secretion, and slow intestinal
transit.  Octreotide is a synthetic analogue of somatostatin, which has been successful in some cases not responding
to other treatments.

Standard dosage                     100 mg two or three times daily

Contraindications                     History of hypersensitivity

Main drug interactions              Diuretics, b-blockers, calcium blockers, insulin, and hypoglycemics

Main side effects                      Bradycardia, arrhythmia, abdominal pain, nausea, vomiting, hyperglycemia,     
                                            hypoglycemia, or flu-like symptoms

Special points                           Use caution in patients with diabetes, cardiac disease, liver disease, and renal disease

Primary Intestinal Lymphangiectasia  Charles M. Bliss, MD and Paul C. Schroy III, MD, MPH