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M J Veysey
a Gastroenterology
Unit, 5th floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK, b Mass Spectrometry Laboratory, St
Thomas's Hospital Campus, UMDS, London, UK, c Department of Endocrinology, St Bartholomew's
Hospital, London, UK, d The
Radcliffe Infirmary, Oxford, UK
Correspondence to: Professor Dowling. Accepted for publication 1 December 1998
BACKGROUND Keywords:
deoxycholic acid;
octreotide;
acromegaly;
gallstones;
large bowel transit time;
mouth to caecum transit time
Treatment of acromegaly
with octreotide increases the proportion of deoxycholic acid in, and
the cholesterol saturation of, bile and induces the formation of
gallstones. Prolongation of intestinal transit has been proposed as the
mechanism for the increase in the proportion of deoxycholic acid in bile.
AIMSTo study the effects of
octreotide on intestinal transit in acromegalic patients during
octreotide treatment, and to examine the relation between intestinal
transit and bile acid composition in fasting serum.
METHODSMouth to caecum and large
bowel transit times, and the proportion of deoxycholic acid in fasting
serum were measured in non-acromegalic controls, acromegalic patients
untreated with octreotide, acromegalics on long term octreotide,
and patients with simple constipation. Intestinal transit and the
proportion of deoxycholic acid were compared in acromegalic patients
before and during octreotide.
RESULTSAcromegalics untreated with
octreotide had longer mouth to caecum and large bowel transit times
than controls. Intestinal transit was further prolonged by chronic
octreotide treatment. There were significant linear relations between
large bowel transit time and the proportion of deoxycholic acid in the total, conjugated, and unconjugated fractions of fasting serum.
CONCLUSIONSThese data support the
hypothesis that, by prolonging large bowel transit, octreotide
increases the proportion of deoxycholic acid in fasting serum (and, by
implication, in bile) and thereby the risk of gallstone formation.
(Gut 1999;44:675-681)
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