Effects of different octreotide dosages on splanchnic hemodynamics and glucagon in patients with TIPS

• Published in: The American journal of gastroenterology Vol. 96; no. 7; pp. 2218 - 2224
• Main Authors: SCHIEDERMAIER, Peter, GÖKE, Burkhard, SAUERBRUCH, Tilman
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.07.2001; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Biological and medical sciences; Blood Flow Velocity - drug effects; Cardiovascular system; Female; Gastroenterology; Glucagon - blood; Hemodynamics - drug effects; Hemostatics - administration & dosage; Hemostatics - blood; Hemostatics - pharmacology; Humans; Male; Medical sciences; Middle Aged; Octreotide - administration & dosage; Octreotide - blood; Octreotide - pharmacology; Pharmacology. Drug treatments; Portal Pressure - drug effects; Portal Vein - diagnostic imaging; Portasystemic Shunt, Transjugular Intrahepatic; Splanchnic Circulation - drug effects; Ultrasonography, Doppler; Vasodilator agents. Cerebral vasodilators; Sonography; Doppler ultrasound study; Human; Regional blood flow; Stomach; Portal circulation disease; Glucagon; Esophageal disease; Splanchnic region; Cardiovascular disease; Octreotide; Statistical study; Hemorrhage; Transjugular intrahepatic portosystemic shunt; Biological activity; Esophagus; Vascular disease; Prevention; Analog; Portal hypertension; Digestive diseases; Somatostatin; Gastric disease; Varix
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2001.03960.x

The aim of this study was to evaluate the hemodynamic effects of octreotide in patients treated with transjugular intrahepatic portosystemic stent shunt in relation to plasma levels of octreotide and glucagon and the correlation between portal pressure and noninvasive Doppler parameters. In 15 fasting patients, we i.v. administered isotonic sodium chloride followed by octreotide 25 microg/h and 100 microg/h, each over 1 h. We measured portal pressure (PP) directly and portal vein blood flow velocity by Doppler ultrasound simultaneously and calculated portal vascular resistance (PVR) and portal venous flow (PVF). Blood samples were taken for glucagon and octreotide (mean +/- SE). Octreotide reduced PP (120': -7.7+/-2.2%, p < 0.01 vs baseline; 180': - 11.4+/-2.1%, p < 0.01 vs baseline) and PVF (120': -21.7+/-31.7%, p < 0.01 vs baseline; 180': -11.6+/-18.1%, p < 0.05 vs baseline). Glucagon decreased with the increase in octreotide levels and showed a correlation with the decrease in PP and with PVF. In patients with a high PVR, we found a close inverse correlation between PP and portal vein blood flow velocity (r = -0.83, p = 0.03) as well as Cl (r = 0.81, p = 0.05), whereas poor correlation was found in patients with low PVR. Octreotide caused a dose-related, moderate but sustained reduction in PP in patients with transjugular intrahepatic portosystemic stent shunt. PVR seems to be an important parameter that influences the efficacy of octreotide and the relation between PP and noninvasive Doppler parameters.