Somatostatin infusion and hemodynamic changes in patients with non-variceal upper gastrointestinal bleeding: a pilot study.
BACKGROUND
Intravenous somatostatin decreases acid secretion, splanchnic blood flow, and portal pressure, but the evidence for its efficacy in the treatment of non-variceal upper gastrointestinal bleeding has been mixed. We aimed to evaluate the vasoactive effect and possible mechanisms of somatostatin infusion in the cessation of non-variceal upper gastrointestinal bleeding.


METHODS
Patients with non-variceal upper gastrointestinal bleeding without portal hypertension were enrolled in the study. They were given somatostatin infusion in a dose of 250 microgr/hour for 72 hours. Superior mesenteric arterial average flow velocity (SMA-V), SMA pulsatility index (SMA-PI), portal venous volume flow (PV-F), and renal artery resistance index (RA-RI) were measured two times for each patient by Doppler ultrasound; once on the first day of infusion therapy and again 6 hours or more after stopping the infusion.


RESULTS
21 patients (12 male, mean age 44.1 +/- 9.9) with bleeding peptic ulcer were enrolled. During somatostatin infusion, PV-F was 33.7 +/- 12.7 cm3/sec. After stopping infusion, it increased to 56.3 +/- 16.0 cm3/sec (p=0.001). SMA-V was 39.7 +/- 13.1 cm/sec and 64.4 +/- 15.1 cm/sec during somatostatin infusion and after cessation of somatostatin respectively (p=0.01). SMA-PI was 2.0 +/- 0.8 during somatostatin infusion but 2.8 +/- 0.8 without somatostatin infusion (p=0.02). However, RA-RI showed no difference between states with or without somatostatin infusion (p>0.05).


CONCLUSIONS
Somatostatin infusion causes a decrease in arterial blood flow to the stomach and duodenum in patients with non-variceal upper gastrointestinal bleeding without portal hypertension. Somatostatin therapy also decreases portal blood flow while not altering renal blood.
Saruç
Murat
M
University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, USA. msaruc@hotmail.com
Can
Mine
M
Küçükmetin
Nurten
N
Tuzcuoglu
Isil
I
Tarhan
Serdar
S
Göktan
Cihan
C
Yüceyar
Hakan
H
D000328:Adult; D004386:Duodenum / Q000098:blood supply / Q000187:drug effects; D004932:Esophageal and Gastric Varices; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006728:Hormones / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012039:Regional Blood Flow; D013004:Somatostatin / Q000494:pharmacology* / Q000627:therapeutic use*; D013223:Statistics as Topic; D013270:Stomach / Q000098:blood supply / Q000187:drug effects; D016896:Treatment Outcome
D006728:Hormones; D013004:Somatostatin