title: Successful use of long-acting octreotide for intractable chronic gastrointestinal bleeding in children.
abstract: OBJECTIVE
  Octreotide reduces splanchnic blood flow and is effective in controlling gastrointestinal bleeding (GIB) caused by portal hypertension. Monthly long-acting octreotide (OCT-LAR) with an efficacy and safety profile similar to subcutaneous daily administration presents an attractive option for long-term therapy. We report our experience with OCT-LAR for severe/recurrent GIB in children with portal hypertension secondary to chronic liver disease or portal vein thrombosis who were unresponsive to standard interventions.
  
  
  METHODS
  A total of 9 patients, 7 boys, who received OCT-LAR between 2000 and 2009 were studied retrospectively (median age at first bleeding 21 months, range 1 month-14.5 years). The dose (2.5-20 mg intramuscularly monthly) was extrapolated from that used in adult acromegaly and neuroendocrine tumours (10-60 mg/mo). Response to treatment was assessed by comparing the number of bleeding events, hospital admissions for acute bleeding, and number of blood units required during the year before and year after starting OCT-LAR.
  
  
  RESULTS
  OCT-LAR led to a reduction in the number of bleeding episodes in all of the children and to cessation of bleeding in 7. Two children listed for transplantation because of severe GIB were removed from the list. No serious adverse effects immediately attributable to OCT-LAR were observed. One child developed growth hormone deficiency and hypothyroidism during a prolonged period of treatment with subcutaneous octreotide before commencing OCT-LAR.
  
  
  CONCLUSIONS
  OCT-LAR can control severe intractable recurrent GIB in children with portal hypertension. Prospective randomised controlled trials and pharmacokinetic studies are indicated to establish the optimum dose and length of treatment of OCT-LAR and confirm its efficacy and long-term safety in children.
authors.affiliation: *Paediatric Liver, GI and Nutrition Centre †Department of Pharmacy, King's College Hospital NHS Foundation Trust, London, UK ‡Department of Paediatrics, S. Maria degli Angeli Hospital, Pordenone §Università Vita-Salute, San Raffaele Hospital ||San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Marie
authors.initials: M
authors.lastname: O'Meara
authors.forename: Maria P
authors.initials: MP
authors.lastname: Cicalese
authors.forename: Andrea
authors.initials: A
authors.lastname: Bordugo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ambrosi
authors.forename: Nedim
authors.initials: N
authors.lastname: Hadzic
authors.forename: Giorgina
authors.initials: G
authors.lastname: Mieli-Vergani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000503:physiopathology; D007223:Infant; D008131:London / Q000453:epidemiology; D008297:Male; D015282:Octreotide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010865:Pilot Projects; D011169:Portal Vein; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013927:Thrombosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D003692:Delayed-Action Preparations; D005765:Gastrointestinal Agents; D015282:Octreotide