| Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding. | |
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MedLine Citation:
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PMID: 11438499 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND AIMS: During acute variceal bleeding, several factors may lead to elevations of hepatic venous pressure gradient (HVPG), which may precipitate further hemorrhage. Whether somatostatin can suppress these increments is unknown. This study monitored somatostatin effects on HVPG during acute bleeding and assessed whether the changes affect outcome. METHODS: In 40 patients with acute variceal bleeding treated with sclerotherapy, a catheter was placed into a main hepatic vein for 24-hour serial measurements of HVPG. After baseline measurements, patients received somatostatin (N = 25) or placebo (N = 15) under double blind conditions. RESULTS: Somatostatin but not placebo produced a sustained decrease in HVPG (from 20.7 +/- 3.7 mm Hg to 17.7 +/- 2.7, P < 0.01). In patients receiving placebo, HVPG increased after a test meal (P = 0.018) and after blood transfusion (P = 0.034). Somatostatin completely prevented these increments. HVPG decreased significantly only in patients without further bleeding. One of 27 patients with HVPG <20 mm Hg at baseline or decreased >10% rebled vs. 9 of 13 who had neither of these 2 criteria (P < 0.0001). Both criteria had independent prognostic value for further bleeding. CONCLUSIONS: During acute variceal bleeding, somatostatin produces a significant and sustained decrease in HVPG and prevents secondary elevations. Monitoring HVPG may stratify further bleeding risk and discriminate treatment response. |
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Authors:
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C Villanueva; J Ortiz; J Miñana; G Soriano; M Sàbat; J Boadas; J Balanzó |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Gastroenterology Volume: 121 ISSN: 0016-5085 ISO Abbreviation: Gastroenterology Publication Date: 2001 Jul |
Date Detail:
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Created Date: 2001-07-04 Completed Date: 2001-07-26 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0374630 Medline TA: Gastroenterology Country: United States |
Other Details:
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Languages: eng Pagination: 110-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Avgda. Sant Antoni Ma. Claret, 167, 08025 Barcelona, Spain. cvillanueva@hsp.santpau.es |
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| MeSH Terms | |
Descriptor/Qualifier:
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Double-Blind Method Female Gastrointestinal Hemorrhage / drug therapy*, therapy Hemodynamics / drug effects* Hormones / therapeutic use* Humans Male Middle Aged Monitoring, Physiologic Portal Pressure / drug effects* Risk Factors Sclerotherapy Somatostatin / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Hormones; 51110-01-1/Somatostatin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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