Administer Octreotide in Variceal Bleeding While Waiting for Endoscopy
Madhavi Meka MD
Cirrhosis affects 3 of 1,000 adults in North America and is responsible for more than 30,000 deaths annually. A major consequence of cirrhosis is variceal bleeding, which contributes significantly to the morbidity and mortality associated with cirrhosis. Obstruction to the portal venous blood flow as seen in cirrhosis, Budd-Chiari syndrome, portal venous thrombosis, portal fibrosis, and other infiltrative diseases causes portal hypertension. Eventually, varices develop to decompress the hypertensive portal vein and return blood to the systemic circulation. Varices usually develop when the portal venous pressure rises above 12 mm Hg (normal value is <5 mm Hg).
What to Do
Various modalities of treatment have been used over the years for treating varices. Previously, vasopressin and terlipressin, which directly constrict the mesenteric arterioles and reduce the portal venous flow, were used in medical management, but they are falling out of favor somewhat due to their ischemic effects on heart, brain, bowel, and limbs. Today, more commonly used drugs in the medical management of variceal bleeds include somatostatin and octreotide. These drugs inhibit the release of vasodilator hormones such as glucagon and indirectly cause splanchnic vasoconstriction. Octreotide is a long-acting synthetic analogue of somatostatin. An intravenous injection of 50-μg bolus followed by continuous infusion of 50 μg/h has been shown to cause significant decrease in the portal pressure. The effect of a single dose of octreotide on reducing portal pressure is effective but short-lived (t1/2 is 3 h in patients with liver disease).