Causes of Carcinoid Syndrome Diarrhea Treatment

Carcinoid syndrome occurs when neuroendocrine tumors located in the gastrointestinal tract or lungs release high levels of hormones and chemicals called serotonin into the bloodstream. Serotonin is responsible for producing numerous symptoms associated with carcinoid syndrome, one of the most common being chronic, watery diarrhea. The excess serotonin in the blood vessels signals the bowel to increase motility and fluid secretion, which causes the stool to become loose or watery.

Dietary and Lifestyle Changes

Carcinoid Syndrome Diarrhea Treatment is making some adjustments to diet and lifestyle can help relieve diarrhea symptoms. Eating smaller, more frequent meals throughout the day is easier to digest than three large meals. High-fiber foods like whole grains, fruits and vegetables should be emphasized as they add bulk to stool. Fatty, spicy and acidic foods may irritate the intestines and worsen diarrhea, so limiting these is recommended. Staying hydrated by drinking plenty of water and electrolyte drinks is important to replace fluids lost from diarrhea. Managing stress through relaxation techniques can also ease abdominal discomfort.

Prescription Medications

Several prescription medications are utilized to control carcinoid syndrome diarrhea. Most work by inhibiting the effects of serotonin in the digestive tract. Octreotide (Sandostatin) is a somatostatin analogue injection administered one to four times per day. Somatostatin is a hormone that regulates the release of serotonin and other chemicals. Octreotide significantly reduces diarrhea episodes in over 80% of patients. Lanreotide (Somatuline Depot) is another somatostatin analogue given as monthly injections. Telotristat ethyl (Xermelo) is a tryptophan hydroxylase inhibitor pill taken three times daily with meals. It reduces tryptophan, an amino acid that serotonin is derived from, lowering serotonin levels.

Therapies to Treat Underlying Cancer

Radiofrequency ablation, cryoablation, or embolization procedures can be performed by interventional radiologists to destroy or block blood supply to neuroendocrine tumors in the liver that are causing symptoms. Surgical removal of the primary tumor and liver metastases may cure some patients if all visible tumors can be resected. For advanced cancers that have spread widely, various chemotherapy regimens containing drugs such as streptozocin, fluorouracil, doxorubicin and capecitabine may shrink tumors and palliate symptoms. peptide receptor radionuclide therapy uses radiolabeled somatostatin analogs that bind to receptors on neuroendocrine tumors to deliver concentrated radiation specifically to cancer cells. This treatment has significantly improved quality of life and outcomes for many. Palliative radiation can also temporarily relieve symptoms from tumors not amenable to other local therapies.

Tips for Managing Breakthrough Diarrhea

Even with optimal treatment, some patients may experience occasional breakthrough diarrhea episodes. Having antidiarrheal medications on hand can help manage these sudden flares. Loperamide (Imodium) is an over-the-counter oral medication that slows gastrointestinal motility. It works best when started at the first loose stool. Colestipol (Colestid) is a bile acid sequestrant that forms a gel in the intestines to absorb excess water and reduce diarrhea episodes by a third. For severe flares, subcutaneous or intravenous octreotide can rapidly relieve diarrhea within 30 minutes. Staying well hydrated, avoiding obvious triggers if possible, and resting during a flare are also recommended.

Supportive Care and Follow Up

A multidisciplinary team approach involving gastroenterologists, oncologists, surgeons and nurse practitioners provides the best care for patients with carcinoid syndrome. Dietitians can create individualized meal plans. Counseling services help cope with the psychological impacts and uncertainty of living with cancer. Routinely monitoring treatment effectiveness through symptoms, biomarkers and imaging scans every 3-6 months determines if adjustments need to be made. With excellent supportive care and continued medical advancements in targeted therapies, many patients experience significantly improved quality of life and long term survival outcomes.

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