Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: a controlled study.
BACKGROUND
Portal hypertensive gastropathy is an important complication of liver cirrhosis and it contributes to acute gastric bleeding. Effective management of this condition remains a clinical challenge. We assessed and compared the efficacy of octreotide, vasopressin, and omeprazole in the treatment of acute bleeding in patients with portal hypertensive gastropathy.


METHODS
Sixty-eight patients with portal hypertensive gastropathy were randomized into Octreotide, Vasopressin, and Omeprazole groups. Bleeding was monitored by observing the contents of the nasogastric tube. Blood transfusion requirements and side-effects of drugs were recorded. Repeat endoscopies were scheduled 2 weeks after treatment.


RESULTS
Complete bleeding control after 48 h of drug infusion was achieved in all patients receiving octreotide (100%), 14/22 patients receiving vasopressin (64%), and 13/22 patients receiving Omeprazole (59%). Octreotide required much less time and significantly fewer blood transfusions to control bleeding. Patients receiving vasopressin experienced more side-effects than those receiving octreotide and omeprazole. In the 17 patients whose bleeding was not controlled within 48 h by either vasopressin or omeprazole, complete bleeding control was achieved by combined use of these two agents. Follow-up endoscopy showed dramatic improvement in gastric mucosal erosions, superficial ulceration and erythema.


CONCLUSIONS
Octreotide appeared to be more effective in controlling acute bleeding in patients with hypertensive gastropathy, with significantly rapid action, smaller transfusion requirements, and minor side-effects. Simultaneous administration of vasopressin and omeprazole appeared to have additive effects.
Zhou
Yongning
Y
Department of Digestive Diseases, Southwest Hospital, The Third Military Medical University, Chong Qing, PR China.
Qiao
Liang
L
Wu
Jing
J
Hu
Haiwen
H
Xu
Caipu
C
D000328:Adult; D000368:Aged; D004341:Drug Evaluation; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D005773:Gastroscopy; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D014667:Vasopressins / Q000627:therapeutic use
D004791:Enzyme Inhibitors; D006490:Hemostatics; D014667:Vasopressins; D009853:Omeprazole; D015282:Octreotide