The role of somatostatin in the management of gastrointestinal bleeding due to portal hypertension

Oesophago-gastric varices and portal hypertensive gastropathy are the two commonest cause of upper gastrointestinal bleeding in portal hypertension. Recently, somatostatin have shown to reduce portal pressure. The work in this thesis include laboratory and clinical studies on the effects of somatostatin in treating these two conditions.;Laboratory studies. In a study on portal hypertensive rats, somatostatin injection has caused significant reduction in portal venous pressure and gastric mucosal blood flow with no significant side effects.;In a group of 20 patients suffering from cirrhosis of the liver, wedged hepatic venous pressure and gastric mucosal blood flow were measured after somatostatin injections. Significant reduction of both parameters were documented.;Clinical studies. In the first study, octreotide infusion was compared with injection sclerotherapy. One hundred consecutive patients were recruited in this study. Bleeding was initially controlled in 90% by emergency sclerotherapy and 84% by octreotide infusion. The difference in success rate of haemostasis between the two groups did not reach statistical significance (P = 0.55). There was no significant difference in early rebleeding (16% vs 14%), blood transfusion (3 units vs 3.5 units), hospital stay (5 days vs 6 days) and hospital mortality (27% vs 20%) between the STD group and the OCT group. No significant side-effects associated with the use of octreotide was reported.;In a second study, the role of octreotide as an adjuvant to endoscopic variceal ligation in preventing rebleeding was addressed. Initial control of bleeding was achieved in 44 out of 47 (93.6%) patients who received variceal ligation alone and in 45 out of 47 (95.7%) in those who received combined treatment (P = 1.0). Recurrent bleeding was documented in 18 (38.3%) patients who received variceal ligation alone and in 4 (8.5%) patients who received combined treatment (P = 0.0007). The blood transfusion requirement was less in the combined therapy group. There was a trend towards lower mortality in the combined therapy group, the differences failed to reach statistical significance.;In conclusion, somatostatin and octreotide are safe and effective drugs for the control of bleeding from gastrooesophageal varices. Its therapeutic role in the treatment of bleeding portal hypertensive gastropathy deserves a large scale prospective study.