However, the effects of early administration of a somatostatin analogue followed by endos. Acute esophageal variceal bleeding is an important cause of morbidity and mortality in patients with cirrhosis. Lack of difference among terlipressin, somatostatin, and. These guidelines were prepared by the department of. In patients with cirrhosis, somatostatin or octreotide administration is followed by a. Endoscopy should be performed within 12 hours of presentation. Jul 03, 2006 whether it is the primary reason for admission or a complication of critical illness, upper gastrointestinal bleeding is commonly encountered in the intensive care unit. The current treatment options for acute variceal hemorrhage include medications vasopressin, somatostatin, and their analogs, endoscopy, transjugular intrahepatic portosystemic shunt placement, and surgery. Divisions of critical care medicine and gastroenterology, miami childrens hospital, miami, florida. The objective of the study was to evaluate the efficacy of intravenous octreotide. Injection sclerotherapy is the most appropriate treatment but facilities for this are not.
Among patients with cirrhosis, varices form at a rate of 5 to 15 percent per year, and onethird of patients with varices will develop variceal hemorrhage. Pdf data are scarce on the headtohead efficacy of terlipressin and octreotide as an adjuvant therapy to endoscopic management of variceal. We report a case of octreotide induced reversible thrombocytopenia in a 54yearold caucasian man with alcoholinduced cirrhosis and upper gastrointestinal bleeding. Current guidelines do not differentiate in the utilization of vasoactive drugs in. Prompt identification and timely treatment of acute variceal bleeding and. Somatostatin or octreotide in acute variceal bleeding abstract. Doc makalah farmakoterapi variceal bleeding putri dewi. Islet cell tumors injectable products only authorization of 12 months may be granted for stabilization of blood glucose levels in patients with. Mortality within 2 weeks after acute bleeding episode is 30%.
Adding medicine to endoscopic treatment works better to control bleeding than endoscopic treatment alone. Patients presenting with esophageal variceal bleeding necessitate immediate medical attention. For suspected variceal bleeding an octreotide infusion should be initiated immediately. Somatostatin and its analogues have been compared with a variety of other treatments for the treatment of variceal bleeding in cirrhotic patients. To prevent further bleeding the drug should be continued for two to five days after endoscopic variceal. Management of acute upper gastrointestinal bleeding. Shah, khalid mumtaz, et al sclerotherapy plus octreotide versus sclerotherapy alone. Six trials only included cirrhotic patients with endoscopically demonstrated variceal bleed ing. Sclerotherapy with or without octreotide for acute variceal bleeding.
For acute episode octreotide, balloon tamponade, emergency endoscopic banding and sclerotherapy are treatment options. Charlina detty v g1f014006 nita triana sari g1f014022 putri dewi riayah g1f014030 ellisa mahardhika g1f014034 puspa juanega s g1f014066 jurusan farmasi fakultas ilmu ilmu kesehatan universitas jenderal soedirman purwokerto 2016 bab i pendahuluan a. Uk guidelines on the management of variceal haemorrhage in. These medicines also may be used along with endoscopic treatment. Endoscopic evidence of variceal bleeding established the baseline condition in all trials table 2. Gastroesophageal varices injectable products only authorization of 6 months may be granted for treatment of acute bleeding of gastroesophageal varices associated with cirrhosis. To compare the role of terlipressin and octreotide in esophageal varices methods. Endoscopic treatment a esophageal varices at the most basic level, band ligation of varices is the treatment of choice in our adaptation. Pdf terlipressin and octreotide in esophageal varices. Terlipressin for the treatment of acute variceal bleeding. Drug treatment for acute upper gastrointestinal bleeding. Allcause mortality, rebleeding, transfused blood harm endpoints. Octreotide acetate is medically necessary for the treatment of bleeding esophageal varices when both of the following criteria are met. The aim of this study was to compare the efficacy and safety of terlipressin with octreotide as an adjuvant therapy to endoscopic variceal band ligation in patients with esophageal variceal bleeding.
In a national audit,5 variceal bleeding accounted for just over 10% of all admissions with acute gi bleeding in the uk, with twothirds having a previous history of variceal bleeding and over 50% presenting during normal working hours. Gastrointestinal bleeding due to variceal hemorrhage can be catastrophic. Octreotide is a longacting synthetic octapeptide analogue of somatostatin and has been used to treat a variety of endocrine problems and esophageal variceal bleeding. Choice of therapy several techniques are available to control variceal bleeding including drug treatment octreotide. About 30% of patients develop variceal bleeding, which is associated with 50% mortality rate. Octreotide therapy for control of acute gastrointestinal. I clinically stratify the patient as low or highrisk for re bleeding and mortality. Prophylactic antibiotic treatment with ceftriaxone or fluoroquinolones norfloxacin ciprofloxacin for not more than 7 days should be initiated for patients with cirrhosis and. Octreotide is the drug of choice for patients with bleeding esophageal varices. The safety of octreotide in patients with variceal bleeding, which has recently been. Emergency sclerotherapy is often employed in such patients to control bleeding. We compared sclerotherapy alone with sclerotherapy and octreotide to control acute variceal bleeding and prevent early rebleeding in patients with cirrhosis.
This drug has a marked clinical importance for patients awaiting endoscopy for esophageal varices diagnosis and. The authors state that as long term octreotide had not been used. Variceal band ligation is recommended as the preferred endoscopic method level 1a, grade a. Somatostatin and octreotide are therapeutic candidates. Octreotide is a synthetic octapeptide with pharmacologic actions similar to the endogenous hormone somatostatin. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding. Somatostatin in acute bleeding oesophageal varices. Our patients platelet count dropped from 155,000mm3 upon admission to. Recurrent bleeding is expected in 6570% of patients who survive the first acute episode. In a recently published metaanalysis, octreotide was shown to improve the control of variceal bleeding compared with alternative medical therapies and placebono intervention.
We identified randomized trials of octreotide for variceal hemorrhage from computerized databases, scientific. Metaanalyses of studies comparing somatostatin or octreotide with vasopressin or terlipressin have shown that somatostatin is somewhat superior to vasop. The aga khan study also documents the difference in. Octreotide for undifferentiated gastrointestinal bleed em. Pdf use of octreotide in the acute management of bleeding. The addition of octreotide to est or evbl resulted in improved control of bleeding and reduced transfusion requirements. Guidelines uk guidelines on the management of variceal. Vasoactive drugs preferable somatostatin or terlipressin should be started as soon as a. Octreotide is the main medicine used in the united states to treat variceal bleeding. Acute hemodynamic effects of octreotide and terlipressin in. Octreotide, a synthetic analogue of somatostatin, has been effective in the management of adult patients with acute bleeding from esophageal varices as well as in decreasing the need for. Gastrointestinal acute variceal bleeding avb is a serious complication in cirrhotic patients with portal hypertension with a high related mortality. A % absolute reduction in bleeding rate was reported with octreotide.
Acute bleeding is that which occurs up to 48 hours after the patient is admitted to any hospital with a bleed. The current treatment options for acute variceal hemorrhage include medications vasopressin, somatostatin, and their analogs, endoscopy, transjugular intrahepatic portosystemic shunt. Pragmatically, augib can be divided into variceal and non variceal ugib nvugib causes, as there are important differences in management strategies. Latar belakang epidemiologi varises bisa terbentuk di setiap lokasi di sepanjang saluran. Endoscopy within 24 h of presentation was achieved in only 66% of all patients and in 70% of patients with. Get a printable copy pdf file of the complete article 989k, or click on a page image below to. A randomized controlled trial comparing octreotide and vasopressin in the control of acute esophageal variceal bleeding. Nov 07, 2017 bleeding anorectal varices most commonly presents as hematochezia bleeding per rectum, which is typically acute or chronic recurrent. Variceal bleeding is a major complication of portal hypertension and represents a. Diagnosis of bleeding esophageal varices associated with liver disease. Octreotide unlicensed is suggested if terlipressin or somatostatin are unavailable level 1a, grade a. Recommendations on the diagnosis and initial management of. Jan 10, 2014 three vasoactive drugsterlipressin, somatostatin, and octreotide play a role in the control of variceal bleeding by reducing portal blood flow and portal pressure.
Balloon tamponade and vasoactive therapy may be used as stop gap measures. Studies of octreotide have not demonstrated a consistent benefit in efficacy or safety compared with conventional therapies. Mar 01, 2001 one direct comparison of octreotide with somatostatin for esophageal variceal bleeding showed a significantly higher transfusion requirement in the patients receiving octreotide. Comparison of terlipressin with octreotide in management of acute. Circumstantial evidence is provided indicating that the mechanisms of action of somatostatin and octreotide in the therapy of bleeding oesophageal varices are mainly mediated by a splanchnic vasoconstrictive effect.
Background in patients with cirrhosis, pharmacologic or endoscopic treatment may control variceal bleeding. Original article the effect of acute variceal bleeding. Early administration of vapreotide for variceal bleeding. Acute hemodynamic effects of octreotide and terlipressin. In this setting, in the absence of endoscopy, intensivists generally provide supportive care transfusion of blood products and acid suppression such as proton pump inhibitors. Endoscopic treatment versus endoscopic plus pharmacologic. Mar 03, 2016 however, the risk of octreotide use is low, and it may provide a small benefit in reducing early re bleeding.
Introduction thrombocytopenia is an extremely rare complication of octreotide therapy and can be life threatening in the setting of esophageal variceal bleeding. Sclerotherapy with or without octreotide for acute variceal. Request pdf octreotide in variceal bleeding bleeding from oesophageal varices has a high death rate. Current guidelines recommend that terlipressin 1 mg should be given. Current guidelines recommend performing an emergency endoscopy as.
Octreotide was the recommended adaptation when urgent endoscopic treatment of active bleeding episodes was not available. It was shown to have comparable efficacy to immediate sclerotherapy for control of bleeding. Keywords terlipressin, somatostatin, esophageal variceal bleeding, physician preference. In one study, continuous infusion of octreotide in seven. The diagnosis of anorectal varices is usually made at endoscopy fig. Pharmacological rationale for the use of somatostatin and. Emergency management of upper gastrointestinal haemorrhage. Acute bleeding from esophageal varices is a major problem in patients with cirrhosis of the liver and is associated with a 30 to 50 percent risk of death. Nonvariceal upper gi bleed acute management inhospital. Octreotide for cirrhosis after variceal bleeding the bmj.
Variceal rebleeding is defined as the occurrence of a new hematemesis or melena after a period of 24 hours or longer from a 24hour timepoint of stable vital signs and hemoglobin after an episode of acute variceal bleeding. Who should have surveillance for variceal bleeding. Somatostatin analogues for acute bleeding oesophageal varices. Makalah farmakoterapi variceal bleeding disusun oleh.
Octreotide unlicensed is suggested if terlipressin or somatostatin are. Patients medical files were excluded if they presented any of the following that might. Octreotide for gastrointestinal hemorrhage from esophageal. Octreotide and terlipressin are probably the two most commonly used drugs worldwide to reduce the rate of acute bleeding from gastroesophageal varices in patients with portal hypertension 15. Our patients platelet count dropped from 155,000mm3 upon admission to 77,000. Case presentation our patients platelet count dropped from 155,000. H 2 receptor antagonists, somatostatin and octreotide are not recommended for non variceal upper gi bleeding. Feb 07, 20 several studies have demonstrated that octreotide reduces the risk of persistent bleeding and recurrent bleeding from variceal and non variceal upper gastrointestinal bleeds. Patients medical files were excluded if they presented any of the. Data are scarce on the headtohead efficacy of terlipressin and octreotide as an adjuvant therapy to endoscopic management of variceal bleed.
This study statistically pooled existing trials to evaluate the safety and efficacy of octreotide for esophageal variceal hemorrhage. Octreotideinvariceal bleeding akburroughs abstract bleeding fromoesophageal varices has a high death rate. Bleeding gastroesophageal varices associated with liver disease octreotide acetate is medically necessary for the treatment of bleeding esophageal varices when both of the following criteria are met. An external file that holds a picture, illustration, etc. The treatment dose for variceal bleeds is with a 50 mcg iv bolus range 25100mcg, followed by 2550 mcghr drip 6. Pdf emergency sclerotherapy compared with somatostatin. Comparison of somatostatin and vasopressin in bleeding esophageal varices. The other ed use for octreotide is in sulfonylurea overdose with hypoglycemia.
Patients medical files were excluded if they presented any of the followin. Hepatic haemodynamics are significantly altered in animals as well as in humans in most of the studies. The mechanism by which octreotide and somatostatin decrease splanchnic blood flow is unknown. Gastrointestinal hemorrhage from variceal hemorrhage. Saari a, klvilaakso e, inberg m, pakkonen m, lahtinen j, hockerstedt k, schroder t.
It is believed that both drugs act as mesenteric vasoconstrictors, thus reducing portal venous. Acute gastrointestinal hemorrhage surgical critical care. Octreotide 100 mcg iv bolus x1, then 2550 mcghr for 25 da. Ii2 predictors of increased risk for re bleeding or death include. In patients with cirrhosis and small varices that have not bled and have no criteria for increased risk of bleeding. The nature of variceal haemorrhage in cirrhotic patients with its complex range of. Bleeding from oesophageal varices has a high death rate. It is widely used in gastroenterology for the management of variceal bleeding, although it is not approved by the food and drug administration for this use and no studies have demonstrated a clear benefit in morbidity, mortality, or sustained control of bleeding compared with. Sclerotherapy with or without octreotide for acute. Thrombocytopenia is an extremely rare complication of octreotide therapy and can be life threatening in the setting of esophageal variceal bleeding. Octreotide for acute gastrointestinal bleeding secondary to portal.
Non variceal variceal bleeding known or suspected octreotide 50 mcg iv bolus, then 50 mcghr infusion antibioticsconsider ceftriaxone endoscopy for banding injection surgery is not indicated consider tipss if endoscopy unsuccessful. If untreated half will re bleed during hospitalization. Compared with vasopressin, terlipressin had a significantly lower risk of. Early use of tips in patients with cirrhosis and variceal. The proportion of variceal bleeding has doubled from 4% in the 1994 audit,4 to 8% in 2007,5 correlating with the increasing burden of liver disease. Shortterm vasoactive agent treatment driven by physicians. Advanced liver failure, failure to control variceal bleeding, early rebleeding, and marked elevations in portal pressure are associated with increased mortality. Injection sclerotherapy is the most appropriate treatment but facilities for this are not always available.
539 539 1315 975 847 1365 1118 1459 1403 1480 157 1184 830 1422 139 1123 1310 609 713 814