Octreotide prevents postprandial splanchnic hyperemia in patients with portal hypertension.
An increase in splanchnic blood flow is a physiological response to food intake. In patients with cirrhosis whose hepatic vascular resistance is already high, this increase in flow leads to marked increases in portal pressure. This study investigates whether octreotide prevents the increases in hepatic flow and portal pressure that follow the ingestion of a meal in patients with cirrhosis. Twenty-two patients with cirrhosis and portal hypertension were randomized to receive a mixed liquid meal (520 kcal) plus a single subcutaneous injection of either placebo or octreotide (200 micrograms). In the placebo group the ingestion of a meal was followed by an increase in the hepatic venous pressure gradient (+ 19.4 +/- 4.3%, p < 0.01) and hepatic blood flow (+ 38.2 +/- 14.6%, p < 0.05) at 30 min. In contrast, in the octreotide group eating caused no significant change in the hepatic venous pressure gradient (-2.8 +/- 3.6%, NS), while hepatic flow was decreased (-6.08 +/- 5.4%, p < 0.05). Octreotide blunted the postprandial increase in serum insulin and glucagon levels observed in the placebo group. In conclusion, in patients with cirrhosis and portal hypertension, octreotide prevents the postprandial increase in hepatic blood flow, and consequently also in portal pressure. These findings suggest that this drug could play a role in the long-term management of portal hypertension.
Servicio de Gastroenterología, Clínica Puerta de Hierro, Madrid, Spain.
A
A
Albillos
I
I
Rossi
J
J
Iborra
J L
JL
Lledó
J L
JL
Calleja
C
C
Barrios
P
P
García
P
P
Escartín
D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004435:Eating / Q000502:physiology*; D005260:Female; D005934:Glucagon / Q000097:blood; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000517:prevention & control*; D006975:Hypertension, Portal / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010919:Placebos; D013152:Splanchnic Circulation / Q000187:drug effects*; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D014655:Vascular Resistance / Q000187:drug effects
D001786:Blood Glucose; D007328:Insulin; D010919:Placebos; D005934:Glucagon; D015282:Octreotide