Lanreotide in the Treatment of Small Bowel Motility Disorders

The investigators hypothesize that in patients with small bowel motility disorders,
Lanreotide helps in alleviating the symptoms. Lanreotide is an FDA approved medication for
management of acromegaly and neuroendocrine tumors, but has never been used for treating
small bowel motility disorders. However, Octreotide which is similar to Lanreotide but is a
short acting synthetic somatostatin has been used in few research studies.

If a patient is interested and qualifies for the study then he/she will be explained about
the study and signature will be collected on the consent form. Health and social history will
be collected. Blood work, urine analysis, pregnancy test (in women of reproductive age group
and have the capability of getting pregnant)) will be performed to make sure that patient
qualifies for the study and for follow-up during the treatment. Physical examination, ECG,
wireless motility capsule testing and hydrogen breath testing will be performed. Patients
will be required to complete a questionnaire regarding their health.

The total study duration from the first administration of study drug is 12 weeks. The study
medication will be given once a month for 3 months and there is a 1 month follow-up after the
last study medication. There will be a screening visit approximately 1 month before the first
study drug administration.

Inclusion Criteria:

1. Consecutive patients with evidence of small bowel motility disorders, referred to (or)
are patients of the Gastroenterology and Motility Center at Northwell Health System.

2. Aged between 18 and 70 years.

3. Subjects should be capable of understanding the study and be able to give informed
consent.

4. Patient having small bowel motility disorder as evidenced by delayed small bowel
transit by wireless motility capsule (WMC) testing to > 6 hours.

5. To participate in the study, patients will have to stop taking Octreotide (because it
has the same mechanism of action as the study medication) if theyare currently taking
it; it should be stopped for at least 4 weeks before taking the first dose of this
study medication.

General Exclusion Criteria

1. Age <18 or age >70

2. Pregnancy as assessed by urine pregnancy test.

Exclusion Criteria for performing wireless motility capsule testing

1. History of gastric bezoar

2. History of Disorders of swallowing

3. Known or suspected small bowel diverticula, diverticulitis, strictures, fistulas,
Crohn's disease, or any other relevant medical comorbidity (e.g. chronic alcohol
abuse)

4. Prior intestinal surgery, including IC valve resection or gastrointestinal surgeries
that create a blind loop (e.g. Bilroth II or Roux-en-Y)

5. History of Severe dysphagia to food or pills

6. A participant who uses an implanted or portable electro-mechanical medical device such
as a cardiac pacemaker or infusion pump

7. Inability to be off intestinal transit altering medication for at least one week (e.g.
opiates, laxatives, etc.)

8. Any person unable or unwilling to undergo abdominal surgery.

9. BMI > 40.

Exclusion Criteria due to Lanreotide

1. Current use or recent (within last 7 days) use of acid suppressive therapy, prokinetic
agents, laxatives, and opiates, or other agents known to affect gastrointestinal
motility.

2. Disorders associated with presumed small intestinal motility disorders including:
scleroderma, intestinal pseudo-obstruction, and autonomic visceral neuropathy (e.g.
longstanding diabetes of more than 20 years and/or poorly controlled diabetes (glucose
> 250, glycosylated hemoglobin (HbA1c) > 8.5%)

3. Current use of cyclosporine (Gengraf, Neoral, or Sandimmune), a medicine called
bromocriptine (Parlodel, Cycloset), or medicines that lower heart rate, such as beta
blockers.

4. Cardiac arrhythmia based on health history (palpitations, feeling a pause between
heartbeats, lightheadedness, passing out, shortness of breath, or chest pain).

Bradycardia and Tachycardia are monitored during every visit to the clinic, using
pulse rate.

ECG will be performed during screening visit and during 8th week of the study. The
following are accessed with ECG.

- Bradycardia <60 beats/min.

- Tachycardia >100 beats/min.

- Atrial Fibrillation - Rapid irregular atrial signal with no real P-waves and
irregular ventricular rate.

- Ventricular Fibrillation - Irregular ventricular waveforms.

- Sinus Arrhythmia - Normal beats, but triggered at an irregular interval from 60
to 100 BPM, causing varying R-R interval.

- Missed beats.

5. Chronic kidney disease (moderate and severe renal impairment as calculated by
creatinine clearance of <50 mL/min)

6. Hepatic Impairment - Subjects with Child-Pugh Class B and Class C.

7. Significant electrolyte abnormalities: Anything outside of the normal range by +/- 20
% will be considered as abnormal.

8. Cholilithiasis (Total bilirubin >2x of normal)

9. Pancreatitis

10. Hepatitis (AST, ALT or Alk Ph, greater than upper limit of normal(ULN), Serum albumin
<3.0 g/dL unless prothrombin time is within the normal range)

11. Present cholecystitis

12. Uncontrolled congestive heart failure

13. Known hypersensitivity to the study drug