Somatostatin in the Treatment of Non-Variceal Upper Gastrointestinal Bleeding

Abstract

The efficacies of somatostatin and octreotide have been widely studied in the control of bleeding from oesophageal varices. It has also been suggested that these drugs may be useful for the control of non-variceal upper gastrointestinal (UGI) bleeding, including that from peptic ulcers. In approximately 80% of patients presenting with non-variceal UGI bleeding, haemorrhage ceases spontaneously and does not recur. However, the remaining 20% of patients require active treatment. Results from recent studies have indicated that somatostatin is an effective treatment for the control of non-variceal UGI bleeding in high-risk patients, i.e. those in whom haemorrhage does not cease spontaneously or is likely to recur. In contrast there is no good evidence available at present to support a role for octreotide in this indication. The efficacy of somatostatin in controlling bleeding in patients with non-variceal UGI bleeding at high risk of mortality upon admission, or rebleeding following endoscopy, coupled with an excellent safety and tolerability profile, suggests that it may be a valuable therapeutic option in the management of non-variceal bleeding.

Should vasoconstrictors be considered in a cirrhotic patient with acute non-variceal upper gastrointestinal bleeding?

“…By comparison, earlier guidelines and reviews suggest that somatostatin should be effective for controlling the non-variceal upper gastrointestinal bleeding [14][15] , which is primarily attributed to the results of an early meta-analysis comparing the outcomes of somatostatin or octreotide versus H 2 antagonists or placebo for the treatment of non-variceal upper gastrointestinal bleeding [16] . But some experts argued that the trials included in the meta-analysis employed the outdated diagnostic and therapeutic approaches [17] .…”

Does Somatostatin Decrease Hemorrhage From Injured Liver in Rats?

“…Intravenous administration of SMT or OCT decreases gastric, pyloric, duodenal, pancreatic and colonic blood flow in rats (Carlsson and Jansson, 1994). It has also been suggested that these drugs may be useful for the control of non-variceal upper gastrointestinal bleeding due to peptic ulcers (Jenkins et al, 1998;Saruc et al, 2003).…”

“…Somatostatin (SMT) has been proposed as a treatment for variceal gastrointestinal bleeding because of its ability to decrease portal pressure without significant adverse systemic effects. The effect of somatostatin is possibly mediated through its ability to cause a splanchnic vasoconstriction and reduction of splanchnic blood flow (Carsson et al, 1994;Cerini et al, 1998;Cirera et al, 1995;Jenkins et al, 1998;Saruc et al, 2003;Sonnenberg et al, 1981). To our knowledge there are no data on the use of SMT in traumatic intra-abdominal hemorrhages.…”

Pharmacotherapy of Acute Non-Variceal Bleeding

“…Jenkins et al [1] review the action and application of unassociated with an ulcerating process. All of these vessels will characteristically have a start-and-stop bleeding somatostatin and its analogue, octreotide.…”

“…The ulcer may be peptic, due to prior effect on pepsin secretion. Jenkins et al [1] have identified some of the potentially critical observations reported and thermal injury (e.g., post-polypectomy or sphincterotomy), traumatic (e.g., Mallory-Weiss tear), or neoplastic, applied these to patients with peptic ulcers: pepsin, especially pepsin 1, tends to have higher activity than in noreither benign (e.g., leiomyoma), or malignant. In patients with a Dieulafoy lesion the exposed vessel is typically mals; the proteolytic activity of pepsin 1 persists despite the high gastric pH, and fibrin clots in the laboratory bleeding and in patients with peptic ulcers.…”