Long‐term haemodynamic effects of octreotide on postprandial splanchnic hyperemia in humans: a placebo‐controlled echo–doppler study

Abstract

Background : Octreotide is a potent splanchnic hypotensive somatostatin analogue effective in the treatment of acute variceal bleeding. Aim : To study the effects of octreotide on basal and postprandial splanchnic and systemic haemodynamics, and hormonal changes in humans. Methods : Twenty‐four healthy volunteers were randomized to receive a liquid meal and either octreotide (OCT, 100 μg bolus) or placebo repeatedly every 4 h for 48 h. Splanchnic (Doppler ultrasound) and systemic haemodynamics (non‐invasive cardiac monitoring) were assessed for 2 h on four consecutive days: one control day and after doses 1 (0 h), 7 (24 h) and 13 (48 h). Results : The maximum postprandial increases in mean blood velocity of the superior mesenteric artery (SMA–Vmean + 72%), portal (PBF + 52%) and total hepatic blood flow (HBF + 50%) observed in the placebo group, were abolished after the first dose of octreotide (SMA–Vmean – 23%, P < 0.01; PBF – 22%, P < 0.01; HBF – 21%, P < 0.01). Postprandial hyperemia was restored at the end of the 48‐h study period, but baseline SMA–Vmean (placebo 40 ± 12, OCT 29 ± 11 cm/s, P < 0.05) and PBF (placebo 1200 ± 971, OCT 743 ± 449 mL/min, P < 0.05) remained significantly lower in the octreotide group. The postprandial decrease of systemic vascular resistance and increase of cardiac index were prevented by octreotide for 48 h. Conclusions : Repeated 4‐hourly bolus injections of octreotide reduce splanchnic blood flow for at least 48 h, but the prevention of food‐induced splanchnic hyperemia is short‐lasting.

Haemodynamic effects of dopexamine on postprandial splanchnic hyperaemia

“…Differences between doses for the same point of measurement were analyzed by the Wilcoxon rank‐sign test for pairwise analysis considering the Bonferroni correction (p/3). Previous studies with analogous design and methods have shown day‐to‐day variance small enough to produce reliable results [17,18]. Statistical significance was considered for P ‐values < 0·05.…”

Role of echo Doppler ultrasonography in the evaluation of postprandial hyperemia in cirrhotic patients

“…By contrast, propranolol is ineffective in blunting postprandial hyperemia but has some effect in reducing postprandial portal blood flow [11] . Somatostatin analogs have a favorable effect in reducing postprandial hyperemia in cirrhotic patients [12][13][14] . Most of these studies are performed by echoDoppler measurement [8,12,13] .…”

“…Somatostatin analogs have a favorable effect in reducing postprandial hyperemia in cirrhotic patients [12][13][14] . Most of these studies are performed by echoDoppler measurement [8,12,13] . Another unexpected finding in the present study was the absence of postprandial hyperemia in 3 patients (data not shown).…”

Assessment of splanchnic blood flow using magnetic resonance imaging

“…within the gut [41]. Besides having effects on metabolism, somatostatin has been reported to induce a decrease in splanchnic blood flow [31,42]. The mode of action of somatostatin is not yet completely understood -it has been suggested that the reduction in splanchnic blood flow is induced through an increase in splanchnic arteriolar resistance and a decrease in portal and portosystemic collateral blood flow [43].…”