Management of diarrhea in patients with carcinoid syndrome

Boris G. Naraev, Magnus Halland, Daniel M. Halperin, Amy J. Purvis, Thomas M. O'Dorisio, Thorvardur R. Halfdanarson

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Neuroendocrine tumors (NETs) arise from enterochromaffin cells found in neuroendocrine tissues, with most occurring in the gastrointestinal tract. The global incidence of NETs has increased in the past 15 years, likely due to better diagnostic methods. Small-bowel NETs are frequently associated with carcinoid syndrome (CS). Carcinoid syndrome diarrhea occurs in 80% of CS patients and poses a substantial symptomatic and economic burden. Patients with CS diarrhea frequently suffer from diarrhea and flushing and report corresponding impairment in quality of life, requiring substantial changes in daily activities and lifestyle. Treatment paradigms range from surgical debulking to liver-directed therapies to treatment with somatostatin analogs, nonspecific anti-diarrheal agents, and a tryptophan hydroxylase inhibitor. Other causes of diarrhea, including steatorrhea, short bowel syndrome, and bile acid malabsorption, should be considered in NET patients with refractory diarrhea. More therapeutic options are needed for symptomatic management of patients with NETs, and better understanding of the pathophysiology can empower clinicians with improved patient care.

Original languageEnglish (US)
Pages (from-to)961-972
Number of pages12
JournalPancreas
Volume48
Issue number8
DOIs
StatePublished - Sep 1 2019

Keywords

  • carcinoid syndrome
  • carcinoid tumors
  • diarrhea
  • neuroendocrine tumors
  • somatostatin analogs
  • telotristat

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

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