Acute Hemodynamic Effects of Octreotide and Terlipressin in Patients with Cirrhosis: A Randomized Comparison

Baik, Soon Koo; Jeong, Phil Ho; Ji, Sang Won; Yoo, Byung Su; Kim, Hyun Soo; Lee, Dong Ki; Kwon, Sang Ok; Kim, Young Ju; Park, Joong Wha; Chang, Sei Jin; Lee, Samuel S.
March 2005
American Journal of Gastroenterology;Mar2005, Vol. 100 Issue 3, p631
Academic Journal
BACKGROUND: Octreotide and terlipressin are widely used in acute variceal hemorrhage to reduce the bleeding rate. They purportedly act by mesenteric arterial vasoconstriction, thus reducing portal venous flow (PVF) and portal pressure. Little is known about the immediate-early hemodynamic effects of these drugs.AIM: To compare the acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis.PATIENTS: Forty-two cirrhotic patients with a history of variceal bleeding were randomized to receive either octreotide 100μg intravenous bolus followed by a continuous infusion at 250μg/h (n= 21), or terlipressin 2 mg intravenous bolus (n= 21).METHODS: Mean arterial pressure (MAP), heart rate (HR), hepatic venous pressure gradient (HVPG), and PVF, assessed by duplex Doppler ultrasonography, were measured before and at 1, 5, 10, 15, 20, and 25 min after the start of drug administration.RESULTS: Octreotide markedly decreased HVPG (−44.5± 17.8%) and PVF (−30.6± 13.6%) compared to the baseline at 1 min (p<0.05). Thereafter, both variables rapidly returned toward the baseline, and by 5 min, no significant differences in HVPG (−7.1± 28.9%) and PVF (10.2± 26.2%) were noted. A similar transient effect on MAP and HR was observed. Terlipressin significantly decreased HVPG (−18.3± 11.9%) and PVF (−32.6± 10.5%) at 1 min (p<0.05) and sustained these effects at all time points. The effects on arterial pressure and HR were also sustained.CONCLUSIONS: Octreotide only transiently reduced portal pressure and flow, whereas the effects of terlipressin were sustained. These results suggest that terlipressin may have more sustained hemodynamic effects in patients with bleeding varices.(Am J Gastroenterol 2005;100:1–5)


Related Articles

  • Propranolol in Primary and Secondary Prophylaxis of Variceal Bleeding Among Cirrhotics in India: A Hemodynamic Evaluation. De, Binay K.; Sen, Sambit; Biswas, Pranab K.; Sengupta, Debapriya; Biswas, Jayanta; Santra, Amal; Hazra, Baburam; Maity, Ajit K. // American Journal of Gastroenterology;Aug2000, Vol. 95 Issue 8, p2023 

    OBJECTIVE: In the present study, we attempted to complete the hemodynamic assessment of propranolol response in cirrhotics with esophageal varices at high risk of bleeding, in one sitting, so as to identify nonresponders at the earliest. Some noninvasive indicators of this response were also...

  • SELF ASSESSMENT ANSWERS: Rectal bleeding in a patient with portal hypertension.  // Postgraduate Medical Journal;Oct2001, Vol. 77 Issue 912, p677 

    This article presents several questions and answers related to rectal bleeding in a patient with portal hypertension. The prevalence of rectal varices in the patients with portal hypertension is quite high. Conservative management may be all that is needed in mild cases and the bleeding may be...

  • Does gastroesophageal reflux have an influence on bleeding from esophageal varices? Okamoto, Eisuke; Amano, Yuji; Fukuhara, Hiroyuki; Furuta, Koichiro; Miyake, Tatsuya; Sato, Shuichi; Ishihara, Shunji; Kinoshita, Yoshikazu // Journal of Gastroenterology;2008, Vol. 43 Issue 10, p803 

    Mucosal breaks induced by gastroesophageal reflux of gastric contents were more frequently found on the right anterior wall of the lower esophagus. Bleeding from esophageal varices may be also derived from gastroesophageal reflux. The circumferential location of the ruptured esophageal varices...

  • Changing Compliance to the American College of Gastroenterology Guidelines for the Management of Variceal Hemorrhage: A Regional Survey. Zaman, Atif; Hapke, Ronald J.; Flora, Kenneth; Rosen, Hugo R.; Benner, Kent G. // American Journal of Gastroenterology;Apr2004, Vol. 99 Issue 4, p645 

    OBJECTIVES: In mid-1997 the American College of Gastroenterology (ACG) published guidelines for the management of varices. The aim of this study is to assess the change in regional practice patterns between early 1997 (preguidelines) and 2000 (postguidelines).METHODS: Gastroenterologists in...

  • varix.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p2438 

    Definitions of the term "varix" are presented. It refers to a tortuous dilatation of a vein or dilatation of an artery or lymph vessel. Definitions of its many forms are also given, including aneurysmal varix, arterial varix, esophageal varix, lymphaticus varix and turbinal varix. Its symptoms...

  • Liver free papers.  // Gut;Apr2005 Supplement 2, Vol. 54, pA6 

    The article presents information on abstracts related to liver. In a abstract endoscopic ligation is compared with propranolol and combined Isosorbide Mononitrates (ISMN) and propranolol to prevent recurrent variceal bleeding. After an attack of bleeding from oesophageal varices, patients are at...

  • Thromboembolic and septic complications of migrated cyanoacrylate injected for bleeding gastric varices. Hamad, N.; Stephens, J.; Maskell, G. F.; Hussaini, S. H.; Dalton, H. R. // British Journal of Radiology;Nov2008, Vol. 81 Issue 971, pe263 

    Endoscopic injection of N-butyl-2-cyanoacrylate combined with radio-opaque lipiodol is widely used to achieve haemostasis in bleeding gastric varices. We present a case of migration of injected cyanoacrylate, thrombus formation and subsequent septic embolisation.

  • Endoscopic Sclerotherapy for Bleeding Rectal Varices: A Case Report. Wang, Michael; Desigan, Gnana; Dunn, Dewey // American Journal of Gastroenterology;Oct1985, Vol. 80 Issue 10, p779 

    Rectal varices are not hemorrhoids and they are dilated submucosal veins connecting the middle and inferior hemorrhoidal veins. These rectal varices may occur in patients with portal hypertension because of the formation of portosystemic shunts. Like esophageal varices, the rectal varices may...

  • Cutaneous Vascular Spiders in Cirrhotic Patients: Correlation with Hemorrhage from Esophageal Varices. Foutch, P. G.; Sullivan, J. A.; Gaines, J. A.; Sanowski, R. A. // American Journal of Gastroenterology;Jul1988, Vol. 83 Issue 7, p723 

    Ninety-two consecutive male cirrhotic patients had esophagoscopy to determine the presence and size of varices, and a concomitant skin examination for assessment of cutaneous vascular spiders. Thirty-one subjects bled from varices within 10 days of the spider evaluation, and this group was...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics