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Increased deoxycholic acid absorption and gall stones in acromegalic patients treated with octreotide: more evidence for a connection between slow transit constipation and gall stones
  1. A F Hofmann
  1. Correspondence to:
    Professor A F Hofmann
    Department of Medicine, MC 0813, University of California, San Diego, La Jolla CA 92093-0813; ahofmannucsd.edu

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Acromegalic patients treated with octreotide have prolonged colonic transit, increased bacterial formation, and subsequent absorption of deoxycholic acid that is indicated by an increased proportion of deoxycholic acid in plasma bile acids. Enrichment of deoxycholic acid in the circulating bile acid pool leads to supersaturated bile and cholesterol gall stones.

Thomas and colleagues,1 in this issue of Gut, extend previous work from the laboratory of R Hermon Dowling by showing that acromegalic patients treated with octreotide have an increase in faecal anaerobic bacteria that convert cholic acid, the major primary bile acid in humans, to deoxycholic acid, the major secondary bile acid (see page 630). The paper also confirms previous reports from the Dowling laboratory2,3 that octreotide treatment increases colonic transit time in acromegalic patients. In addition, the paper of Thomas et al shows that octreotide treatment results in enrichment of deoxycholic acid in fasting state plasma bile acids.

The present paper is the 11th and could well be the last in a series of papers spanning more than a decade from the Dowling laboratory that have dealt with the pathogenesis of gall stones in acromegalic patients treated with octreotide, a potent somatostatin agonist. Octreotide is a synthetic peptide whose amide bonds are resistant to hydrolysis by plasma peptidases, thus resulting in its having a much longer duration of action than that of somatostatin.4 In acromegalic patients, octreotide administration suppresses the release of growth hormone and insulin growth factor by the pituitary and results in clinical improvement.5

The initial paper in this series showed that such patients have an increased prevalence of gall stones.6 The gall stones were shown to be rich in cholesterol7 and, as would be expected, bile was found to be supersaturated in cholesterol8 and to …

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