Why is octreotide used in varices?
Octreotide is frequently used in the ED for patients with a history of cirrhosis who present with a moderate or severe upper GI bleed presumed to be from a variceal source. Octreotide inhibits the release of glucagon, which is a splanchnic vasodilator.
How does octreotide help with GI bleed?
Sandostatin (octreotide acetate) may help treat certain types of bleeding in the gastrointestinal (GI) tract through various mechanisms, including its ability to: Reduce blood flow in the gastrointestinal system. Inhibit stomach acids. Decrease the clumping of platelets.
Is octreotide used for esophageal varices?
Octreotide has been shown to be at least as effective as vasopressin in the treatment of bleeding varices, with fewer and less severe systemic adverse effects. In addition, octreotide has also been consistently associated with a decreased need for transfusions.
Why is vasopressin given to patients with bleeding from esophageal varices?
Vasopressin has been used for 25 years to control bleeding from esophageal varices. Its efficacy is believed to be due to a direct vasoconstrictor activity on splanchnic arterioles and precapillary sphincters, with secondary reduction in portal venous blood flow and pressure.
How do beta blockers prevent variceal bleeding?
Beta blockers — Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside of the varices, which can reduce the risk of bleeding by 45 to 50 percent [1].
Is vasopressin used for GI bleed?
Vasopressin is a potent vasoconstrictor which greatly reduces mesenteric blood flow. In patients with portal hypertension this results in decreased portal venous flow and portal pressure. Because of this property, vasopressin has been used for years in the therapy of variceal haemorrhage.
Why does bun increase with GI bleed?
Blood urea nitrogen (BUN) represents the terminal products of protein metabolism via ammonia. When upper GI bleeding occurs, the blood is digested to protein metabolized to BUN in the urea cycle within the liver. Higher BUN values are therefore associated with the digestion of blood.
How does vasopressin treat esophageal varices?
How does vasopressin decreased portal pressure?
Vasopressin is the most potent splanchnic vasoconstrictor; it reduces blood flow to all splanchnic organs, decreasing portal venous inflow and portal pressure.
Which is better octreotide or vasopressin for variceal bleeding?
Abstract. No specific alternative therapy demonstrated a mortality benefit. Conclusions: These results favor octreotide over vasopressin/terlipressin in the control of esophageal variceal bleeding and suggest it is a safe and effective adjunctive therapy after variceal obliteration techniques.
Which is the best endoscopic banding for varices?
Endoscopic banding of varices is preferred over injection sclerotherapy. At the same time, IV octreotide (a synthetic analog of somatostatin, which may also be used) should be given. Octreotide increases splanchnic vascular resistance by inhibiting the release of splanchnic vasodilator hormones (eg, glucagon, vasoactive intestinal peptide).
Are there any studies on octreotide for esophageal hemorrhage?
Background & Aims: Studies of octreotide have not demonstrated a consistent benefit in efficacy or safety compared with conventional therapies. This study statistically pooled existing trials to evaluate the safety and efficacy of octreotide for esophageal variceal hemorrhage.
Where does the bleeding from a varice come from?
Bleeding is usually from the distal esophagus, less often from the gastric fundus. Bleeding from gastric varices also may be acute but is more often subacute or chronic.