Octreotide bolus injection and azygos blood flow in patients with cirrhosis: is the effect really predictable?
BACKGROUND
Octreotide (OCT) improves the management of variceal bleeding, but the pattern of administration is not clearly defined. Available data show a transient decrease in portal pressure and azygos blood flow (AzBF) after OCT bolus injection with desensitization at readministration.


OBJECTIVE
To explore the sustained hemodynamic effects of OCT and changes associated with readministration at 60 minutes on AzBF in patients with portal hypertension.


METHODS
AzBF was measured invasively (thermodilution technique) in 12 patients at baseline and at 10 minutes intervals after OCT 50-μg IV bolus for a total of 60 minutes. Readministration of OCT was followed by AzBF measurement for another 15 minutes. Patients [age 51.4 y (30 to 69)] had cirrhosis (alcoholic in 9 patients; Pugh's score 8.8±0.3), portal hypertension (HVPG 19±1 mm Hg), and elevated AzBF (658±138 mL/min).


RESULTS
The bolus of OCT was followed at 10 minutes by a 34% decline in AzBF as compared with baseline value. This AzBF reduction was sustained over the 60-minute study period (-36%±1.4%) with the values that remained decreased as compared with baseline (P<0.01). Mean arterial pressure remained stable. At 60 minutes, the repeat OCT bolus induced a further significant (P<0.01) decline in AzBF, although the response was blunted (-18%±1.2%).


CONCLUSIONS
The AzBF showed a sustained decrease of value after a bolus injection of 50-μg OCT. A further hemodynamic response is detectable at OCT readministration after 60 minutes. The pattern of hemodynamic response to OCT may not be uniform among cirrhotics.
Spahr
Laurent
L
Gastroenterology and Hepatology Unit, University Hospitals, Geneva, Switzerland. Laurent.Spahr@hcuge.ch
Giostra
Emiliano
E
Mentha
Gilles
G
Hadengue
Antoine
A
D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000187:drug effects; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000494:pharmacology*; D017082:Portal Pressure / Q000187:drug effects*; D013815:Thermodilution; D013997:Time Factors
D005765:Gastrointestinal Agents; D015282:Octreotide