A Decade of Octreotide

complications following pancreatic surgery). Somatostatin analogues including octreotide have been shown to reduce pressure in the splanchnic circulation, an effect that was exploited in the management of variceal and nonvariceal hemorrhages. Despite a widespread therapeutic application, octreotide seems to be a safe drug free of major side effects. Somatostatin, a peptide hormone initially isolated from ovine hypothalami, has been documented to inhibit the release of growth hormone. It soon became evident that this peptide was not only present in the brain but was widely distributed in the stomach, the gastrointestinal tract and the pancreas. By 1980, the gene encoding for prosomatostatin had been identified and it became eviMost of the reported side effects are gastrointestinal in dent that different molecular forms are present in the nature and include steatorrhea, bloating, minor nausea, body. Later on, different receptors for somatostatin were gallstones and mild forms of glucose intolerance. Recently identified and it became clear that the different molecular a new formulation of octreotide, octreotide LAR (longforms and the different receptors are part of a complicated acting repeatable), was developed which enables once-acontrol system which regulate a variety of body functions. month administration. Octreotide LAR combines over a Somatostatin molecules exert profound inhibitory funcdecade of proven benefits of the subcutaneous octreotide tions, not only on growth hormone secretion but also on administration with a more convenient formulation for many gastrointestinal functions. These different effects long-term treatment of a variety of diseases. Onceform the basis for an enormous therapeutic potential of monthly administration should improve patient acceptasomatostatin in different diseases. The short half-life of bility and compliance; it represents a significant advance natural somatostatin which necessitates a continuous inin the management of a number of conditions associated travenous infusion has made it difficult to transform the with excessive peptide secretion (acromegaly, neuroendonatural peptide into a successful drug. It was therefore a crine tumors). There is no doubt that additional indicamajor step forward when a synthetic analogue of somatotions will emerge as investigations continue. Treatment of statin, octreotide, was synthesized and became available certain gastrointestinal cancers and prevention of variceal for clinical use in the mid-eighties. For over a decade, bleeding are two clinical areas which are currently under subcutaneous octreotide has proven effective in the treatinvestigation. A decade of octreotide has been beneficial ment of acromegaly and in several clinical areas relating for many patients; hopefully many more will be able to to gastroenterology and digestive surgery. The ability of take advantage of this fascinating peptide. octreotide to control symptoms such as diarrhea or flush caused by gut-neuroendocrine tumors soon became evident. Subsequently, octreotide was used in other forms of secretory diarrhea (AIDS-related diarrhea, idiopathic Bern and Basel Markus W. Buchler diarrhea, diabetic diarrhea) but also in the management January 1999 Christoph Beglinger of pancreatic disorders (pancreatic fistulae, prevention of