Effects of terlipressin and somatostatin on liver and thorax blood volumes in patients with cirrhosis.
BACKGROUND
Variceal bleeding in cirrhosis can cause liver ischaemia and deteriorate the hyperdynamic state; thus, the effects of vasoconstrictor therapy on liver blood volume (LBV) and thorax blood volume (ThBV) are important.


OBJECTIVE
To evaluate and compare the effects of terlipressin and somatostatin on LBV and ThBV in stable patients with cirrhosis and portal hypertension.


METHODS
Twenty patients were studied (Child-Pugh class A/B/C: 5/8/7). The radioactivities in the liver region (LRR) and the thorax region (ThRR) by single-head gamma camera technique, as indicators of LBV and ThBV, respectively, and systemic haemodynamics were measured at baseline and after intravenous infusion of 2 mg of terlipressin (n=10) or somatostatin 250 mg/h after an initial bolus of 250 mg (n=10).


RESULTS
LRR and ThRR decreased significantly with increasing severity of cirrhosis. Thirty minutes after terlipressin infusion, LRR and ThRR increased by 7.8 ± 4.4% (NS) and 14 ± 5.3% (P=0.01) compared with baseline values; the increase in ThRR was significantly related to the increase in LRR (r=0.682, P=0.03). In contrast, somatostatin reduced LRR and ThRR by 13.3 ± 6.5% (P=0.07) and 1 ± 4% (NS) respectively. LRR and ThRR increased significantly in the terlipressin group compared with the somatostatin group (P=0.01 and P=0.02 respectively). Terlipressin reduced cardiac output and heart rate (both P=0.01) and increased the mean arterial pressure (MAP) and systemic vascular resistance (P=0.009 and P=0.002 respectively); MAP decreased after somatostatin infusion (P=0.03).


CONCLUSIONS
Terlipressin, but not somatostatin, maintains LBV, increases ThBV and improves the hyperdynamic state in cirrhosis. These effects can be beneficial in variceal bleeding, particularly in patients with advanced liver disease.
Kalambokis
George
G
1st Division of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Tsiouris
Spyridon
S
Tsianos
Epameinondas V
EV
Baltayiannis
Gerasimos
G
Pakou
Barbara
B
Fotopoulos
Andreas
A
D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D015902:Gamma Cameras; D006439:Hemodynamics / Q000187:drug effects; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D007262:Infusions, Intravenous; D008102:Liver Circulation / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013004:Somatostatin / Q000627:therapeutic use*; D017256:Technetium Tc 99m Sestamibi; D000077585:Terlipressin; D013909:Thorax / Q000098:blood supply* / Q000000981:diagnostic imaging; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D006728:Hormones; D019275:Radiopharmaceuticals; D014662:Vasoconstrictor Agents; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin; D017256:Technetium Tc 99m Sestamibi