Liver, Pancreas, and Biliary TractDesensitization to the effects of intravenous octreotide in cirrhotic patients with portal hypertension☆,☆☆
Section snippets
Patients and methods
The study included 68 patients with cirrhosis, portal hypertension, and esophageal varices who were referred for evaluation to the Hepatic Hemodynamic Laboratory (Barcelona, Spain). Twenty-seven patients were women and 41 were men; the mean age was 55 ± 13 years (mean ± SD; range, 20–75 years). Twenty-four patients had previously bled from varices, whereas the remaining 44 had not. Additional data are shown in Table 1.All patients gave written informed consent to participate in the study, which
Baseline data
There were no statistically significant differences among patients allocated to receive the different schedules of octreotide or placebo administration in age, sex, body weight, etiology of cirrhosis, severity of liver failure, and baseline hemodynamic parameters (Tables 1-5).All patients had severe portal hypertension, as shown by the presence of gastroesophageal varices and by a high baseline HVPG, averaging 18 ± 3.3 mm Hg. In addition, all groups of patients had increased AzBF, CO, and
Discussion
Somatostatin and octreotide are different molecules that bind with a different affinity to somatostatin receptors (SSTR). Octreotide binds with a similar affinity as somatostatin for SSTR2 and SSTR5, has intermediate affinity for SSTR3, and no binding affinity for SSTR1 and SSTR4.2
Although the rationale for the use of octreotide in variceal bleeding comes from the hypothesis that, similar to native somatostatin, it may reduce portal pressure and blood flow, the hemodynamic effects of octreotide
Acknowledgements
The authors thank Àngels Baringo, Laura Rocabert, and Rosa Sáez for providing expert technical assistance.
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Address requests for reprints to: Jaume Bosch, M.D., Liver Unit, Hospital Clínic, C/ Villarroel, 170, 08036 Barcelona. e-mail: [email protected]; fax: (34) 93-451-5522.
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Supported in part by grants from the Fondo de Investigaciones Sanitarias (FIS 00/0444) and by Sandoz SA.