Octreotide in the treatment of refractory ascites of cirrhosis

Abstract

Dietary sodium restriction and diuretic treatment have been shown to be effective in the treatment of ascites in the majority of cirrhotic patients. However, approximately 5 to 10% of patients develop refractory ascites, which is defined as ascites that does not respond to intensive diuretic therapy (diuretic-resistant) or ascites that cannot be controlled because the patient develops diuretic-induced complications that prevent the use of an effective diuretic dose (diuretic-intractable). Current therapeutic approaches for refractory ascites include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunting. In the present report, subcutaneous octreotide treatment improved renal function and hemodynamics and diuretic response in two patients with refractory ascites in line with a marked decrease in renin and aldosterone secretion. We consider that octreotide could be of value in the management of refractory ascites in cirrhotic patients.

The effect of 1 month of therapy with midodrine, octreotide‐LAR and albumin in refractory ascites: a pilot study

“…Owing to the lack of a 24‐h urine volume at 2 weeks, the early increase in natriuresis cannot be supported definitively. If present, it would be in keeping with previous studies using midodrine (13, 18), albumin (19, 20) or subcutaneous octreotide (21). The subsequent modulation of natriuresis by the end of the study is suggestive of tachyphylaxis, a plateau effect inferred from the report by Angeli et al (22).…”

Management of adult patients with ascites due to cirrhosis: An update

“…Another pilot randomized trial of paracentesis plus albumin versus clonidine plus spironolactone in patients with cirrhosis, refractory ascites, and a plasma norepinephrine level of >300 pg/mL demonstrated fewer hospitalizations in the latter group 117. A pilot study of subcutaneous octreotide in two patients with refractory ascites demonstrated an improvement in renal function and hemodynamics and a reduction in renin and aldosterone 118. Clearly, more data are needed before these experimental options can be placed in the treatment algorithm.…”

Octreotide in the treatment of refractory ascites of cirrhosis

“…It has also been reported that longterm octreotide treatment can ameliorate peripheral vasodilation and sodium retention in these rats [4,5]. In cirrhotic patients with ascites, whether refractory [6] or not [7], octreotide can improve renal function and diuretic response possibly as a result of a direct decrease of renin and alsosterone secretion. However, octreotide alone does not seem to improve renal function or sodium excretion in cirrhotic patients with ascites [8,9].…”