[Splanchnic hemodynamic effects of somatostatin and octreotide in cirrhotic patients. A Doppler ultrasonographic study].
OBJECTIVE
Doppler-ultrasound assessment of the splanchnic hemodynamic effects of intravenous somatostatin and octreotide administration.


METHODS
Forty-five cirrhotic patients with esophageal varices were randomized to receive 1-hour intravenous somatostatin (SOM, 250 mg), octreotide (OCT, 50 mg), or placebo (PLA). In baseline and at 15, 30, 45 and 60 minutes of infusion, mean velocity, congestion index, flow volume and diameter of the portal vein, as well as the superior mesenteric artery resistivity index, were measured. Plasma bradykinine and vasoactive intestinal peptide (VIP) concentrations were also measured at baseline and at 30 and 60 minutes.


RESULTS
While placebo caused no changes in any of the venous and arterial parameters, SOM and OCT caused a sustained decrease in portal vein velocity (-19.41 vs. -11.19%) and flow (-22.79 vs. -12.33%), and an increase in the congestion index (+17.5 vs. +7.5%) and resistivity index of the superior mesenteric artery (+7.18 vs. +6.16%) with respect to baseline (p < 0.05). These changes were already evident at 15 minutes and remained unchanged during the time of the study period. With respect to OCT, SOM caused a higher reduction in mean velocity and flow of the portal vein, with no significant differences for congestion index and mesenteric artery resistivity index, both increased by SOM and OCT. Plasma bradykinine and VIP concentrations remained unchanged in the three groups.


CONCLUSIONS
At therapeutic doses, intravenous somatostatin and octreotide reduce portal vein velocity and flow, and increase portal vein congestion index and superior mesenteric artery resistivity index. Somatostatin causes a higher portal flow reduction than octreotide in spite of a similar splanchnic arterial effect.
Fernández Pérez
F J
FJ
Unidad de Aparato Digestivo, Ctra, Hospital Costa del Sol, Nacional 340, km 187. 29600 Marbella, Málaga, Spain. pacof@hcs.es
Jiménez Sáenz
M
M
García Montes
J M
JM
Rebollo Bernárdez
J
J
Herrerías Gutiérrez
J M
JM
D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007262:Infusions, Intravenous; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D011169:Portal Vein / Q000187:drug effects* / Q000502:physiology*; D012039:Regional Blood Flow / Q000187:drug effects; D013004:Somatostatin / Q000627:therapeutic use*; D013152:Splanchnic Circulation / Q000187:drug effects*; D018608:Ultrasonography, Doppler
D005765:Gastrointestinal Agents; D013004:Somatostatin; D015282:Octreotide