Document Detail


Somatostatin treatment and risk stratification by continuous portal pressure monitoring during acute variceal bleeding.
MedLine Citation:
PMID:  11438499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
C Villanueva; J Ortiz; J Miñana; G Soriano; M Sàbat; J Boadas; J Balanzó
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gastroenterology     Volume:  121     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-07-04     Completed Date:  2001-07-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  110-7     Citation Subset:  AIM; IM    
Affiliation:
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:
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:
0/Hormones; 51110-01-1/Somatostatin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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