PMID: 10776959

Issn Print: 0277-2116

Publication Date: 2000/04/01


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Efficacy of Octreotide in Children With Chronic Gastrointestinal Bleeding

Aglaia Zellos; Kathleen B. Schwarz

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Excerpt

Chronic gastrointestinal bleeding in children is an infrequent but frustrating problem for clinicians. Multiple endoscopic and radiologic procedures are sometimes required to determine the origin of bleeding. Occasionally, the source of bleeding is not found during the initial episode, and patients are subjected to the risk and expense of repeated transfusions, diagnostic procedures, and hospital admissions. In selected patients, in whom diagnosis is established, interventions such as endoscopic hemostasis, embolization of selected mesenteric artery branches, and surgery may be successful (1). However, rebleeding may occur in patients with multifocal or cryptogenic lesions.
Octreotide, a somatostatin analogue that is thought to decrease splanchnic blood flow (2), has been reported to induce cessation of bleeding in adults with acute variceal hemorrhage (3). It has also been effective in the treatment of chronic gastrointestinal bleeding in adults, secondary to intestinal angiodysplasia (4,5). In children, octreotide administered intravenously has been effective in decreasing acute gastrointestinal bleeding of various causes (6). However, there is limited information regarding the efficacy and safety of octreotide for chronic gastrointestinal bleeding in children. Because somatostatin inhibits the secretion of growth hormone, thyrotropin, glucagon, and insulin (7) and decreases bile flow (8,9), the major theoretical complications of long-term octreotide therapy include decreased linear growth velocity, hypothyroidism, diabetes, and cholestasis.
We report the successful management of chronic severe gastrointestinal bleeding in three children with the daily use of subcutaneous octreotide (Sandostatin; Sandoz Pharmaceuticals, Basel Switzerland) for 24 to 50 months without significant side effects and with significant reduction in transfusion requirement and in need for gastrointestinal diagnostic procedures.
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