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Erschienen in: Critical Care 4/2006

01.08.2006 | Review

Pro/con debate: Octreotide has an important role in the treatment of gastrointestinal bleeding of unknown origin?

verfasst von: Yaseen Arabi, Bandar Al Knawy, Alan N Barkun, Marc Bardou

Erschienen in: Critical Care | Ausgabe 4/2006

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Abstract

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. 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). More recently, octreotide (a somatostatin analogue) has been used in such patients. However, its precise role in patients with upper gastrointestinal bleeding is not necessarily clear and the drug is associated with significant costs. In this issue of Critical Care, two expert teams debate the merits of using octreotide in non-variceal upper gastrointestinal bleeding.
Literatur
1.
Zurück zum Zitat Reubi JC, Schaer JC, Laissue JA, Waser B: Somatostatin receptors and their subtypes in human tumors and in peritumoral vessels. Metabolism 1996,45(Suppl 1):39-41. 10.1016/S0026-0495(96)90077-3CrossRefPubMed Reubi JC, Schaer JC, Laissue JA, Waser B: Somatostatin receptors and their subtypes in human tumors and in peritumoral vessels. Metabolism 1996,45(Suppl 1):39-41. 10.1016/S0026-0495(96)90077-3CrossRefPubMed
2.
Zurück zum Zitat Nevens F: Review article: a critical comparison of drug therapies in currently used therapeutic strategies for variceal haemorrhage. Aliment Pharmacol Ther 2004,20(Suppl 3):18-22. discussion 23 10.1111/j.1365-2036.2004.02110.xCrossRefPubMed Nevens F: Review article: a critical comparison of drug therapies in currently used therapeutic strategies for variceal haemorrhage. Aliment Pharmacol Ther 2004,20(Suppl 3):18-22. discussion 23 10.1111/j.1365-2036.2004.02110.xCrossRefPubMed
3.
Zurück zum Zitat Ludwig D, Schadel S, Bruning A, Schiefer B, Stange EF: 48-hour hemodynamic effects of octreotide on postprandial splanchnic hyperemia in patients with liver cirrhosis and portal hypertension: double-blind, placebo-controlled study. Dig Dis Sci 2000, 45: 1019-1027. 10.1023/A:1005553914878CrossRefPubMed Ludwig D, Schadel S, Bruning A, Schiefer B, Stange EF: 48-hour hemodynamic effects of octreotide on postprandial splanchnic hyperemia in patients with liver cirrhosis and portal hypertension: double-blind, placebo-controlled study. Dig Dis Sci 2000, 45: 1019-1027. 10.1023/A:1005553914878CrossRefPubMed
4.
Zurück zum Zitat Clarke DL, McKune A, Thomson SR: Octreotide lowers gastric mucosal blood flow in normal and portal hypertensive stomachs. Surg Endosc 2003, 17: 1570-1572. 10.1007/s00464-002-9274-zCrossRefPubMed Clarke DL, McKune A, Thomson SR: Octreotide lowers gastric mucosal blood flow in normal and portal hypertensive stomachs. Surg Endosc 2003, 17: 1570-1572. 10.1007/s00464-002-9274-zCrossRefPubMed
5.
Zurück zum Zitat Sgouros SN, Bergele C, Viazis N, Avgerinos A: Somatostatin and its analogues in peptic ulcer bleeding: facts and pathophysiological aspects. Dig Liver Dis 2006, 38: 143-148. 10.1016/j.dld.2005.11.012CrossRefPubMed Sgouros SN, Bergele C, Viazis N, Avgerinos A: Somatostatin and its analogues in peptic ulcer bleeding: facts and pathophysiological aspects. Dig Liver Dis 2006, 38: 143-148. 10.1016/j.dld.2005.11.012CrossRefPubMed
6.
Zurück zum Zitat D'Amico G, Pietrosi G, Tarantino I, Pagliaro L: Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients. Cochrane Database Syst Rev 2002, (1):CD002233. D'Amico G, Pietrosi G, Tarantino I, Pagliaro L: Emergency sclerotherapy versus medical interventions for bleeding oesophageal varices in cirrhotic patients. Cochrane Database Syst Rev 2002, (1):CD002233.
7.
Zurück zum Zitat Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M, Ruizdel-Arbol L, Salcedo M, Molinero LM: Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002, 35: 609-615. 10.1053/jhep.2002.31354CrossRefPubMed Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M, Ruizdel-Arbol L, Salcedo M, Molinero LM: Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002, 35: 609-615. 10.1053/jhep.2002.31354CrossRefPubMed
8.
Zurück zum Zitat Zhou Y, Qiao L, Wu J, Hu H, Xu C: Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: a controlled study. J Gastroenterol Hepatol 2002, 17: 973-979. 10.1046/j.1440-1746.2002.02775.xCrossRefPubMed Zhou Y, Qiao L, Wu J, Hu H, Xu C: Comparison of the efficacy of octreotide, vasopressin, and omeprazole in the control of acute bleeding in patients with portal hypertensive gastropathy: a controlled study. J Gastroenterol Hepatol 2002, 17: 973-979. 10.1046/j.1440-1746.2002.02775.xCrossRefPubMed
9.
Zurück zum Zitat Palmer KR: Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002, 51: 1iv-6.CrossRef Palmer KR: Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002, 51: 1iv-6.CrossRef
10.
Zurück zum Zitat Leontiadis GI, Sharma VK, Howden CW: Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ 2005, 330: 568-575. 10.1136/bmj.38356.641134.8FPubMedCentralCrossRefPubMed Leontiadis GI, Sharma VK, Howden CW: Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ 2005, 330: 568-575. 10.1136/bmj.38356.641134.8FPubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Barkun A, Bardou M, Marshall JK, for the Nonvariceal Upper GIBCCG: Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding. Ann Intern Med 2003, 139: 843-857.CrossRefPubMed Barkun A, Bardou M, Marshall JK, for the Nonvariceal Upper GIBCCG: Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding. Ann Intern Med 2003, 139: 843-857.CrossRefPubMed
12.
Zurück zum Zitat Cook DJ, Griffith LE, Walter SD, Guyatt GH, Meade MO, Heyland DK, Kirby A, Tryba M: The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001, 5: 368-375. 10.1186/cc1071PubMedCentralCrossRefPubMed Cook DJ, Griffith LE, Walter SD, Guyatt GH, Meade MO, Heyland DK, Kirby A, Tryba M: The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001, 5: 368-375. 10.1186/cc1071PubMedCentralCrossRefPubMed
13.
Zurück zum Zitat Erstad BL: Octreotide for acute variceal bleeding. Ann Pharmacother 2001, 35: 618-626. 10.1345/aph.10316CrossRefPubMed Erstad BL: Octreotide for acute variceal bleeding. Ann Pharmacother 2001, 35: 618-626. 10.1345/aph.10316CrossRefPubMed
14.
Zurück zum Zitat Andriulli A, Annese V, Caruso N, Pilotto A, Accadia L, Niro AG, Quitadamo M, Merla A, Fiorella S, Leandro G: Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol 2005, 100: 207-219. 10.1111/j.1572-0241.2005.40636.xCrossRefPubMed Andriulli A, Annese V, Caruso N, Pilotto A, Accadia L, Niro AG, Quitadamo M, Merla A, Fiorella S, Leandro G: Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol 2005, 100: 207-219. 10.1111/j.1572-0241.2005.40636.xCrossRefPubMed
15.
Zurück zum Zitat Khuroo MS, Farahat KL, Kagevi IE: Treatment with proton pump inhibitors in acute non-variceal upper gastrointestinal bleeding: a meta-analysis. J Gastroenterol Hepatol 2005, 20: 11-25. 10.1111/j.1440-1746.2004.03441.xCrossRefPubMed Khuroo MS, Farahat KL, Kagevi IE: Treatment with proton pump inhibitors in acute non-variceal upper gastrointestinal bleeding: a meta-analysis. J Gastroenterol Hepatol 2005, 20: 11-25. 10.1111/j.1440-1746.2004.03441.xCrossRefPubMed
16.
Zurück zum Zitat Daneshmend TK, Hawkey CJ, Langman MJ, Logan RF, Long RG, Walt RP: Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial. BMJ 1992, 304: 143-147.PubMedCentralCrossRefPubMed Daneshmend TK, Hawkey CJ, Langman MJ, Logan RF, Long RG, Walt RP: Omeprazole versus placebo for acute upper gastrointestinal bleeding: randomised double blind controlled trial. BMJ 1992, 304: 143-147.PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Lau JY, Leung WK, Wu JC, Chan FK, Wong V, Hung LC, Cheung K, Yung M, Lee VW, Chiu PW, et al.: Early administration of high-dose intravenous omeprazole prior to endoscopy in patients with upper gastrointestinal bleeding; a double blind placebo controlled randomized trial. Gastroenterology 2005, 128: A-50. 10.1053/j.gastro.2004.12.046CrossRef Lau JY, Leung WK, Wu JC, Chan FK, Wong V, Hung LC, Cheung K, Yung M, Lee VW, Chiu PW, et al.: Early administration of high-dose intravenous omeprazole prior to endoscopy in patients with upper gastrointestinal bleeding; a double blind placebo controlled randomized trial. Gastroenterology 2005, 128: A-50. 10.1053/j.gastro.2004.12.046CrossRef
18.
Zurück zum Zitat Kubba AK, Dallal H, Haydon GH, Hayes PC, Palmer KR: The effect of octreotide on gastroduodenal blood flow measured by laser Doppler flowmetry in rabbits and man. Am J Gastroenterol 1999, 94: 1077-1082. 10.1111/j.1572-0241.1999.929_b.xCrossRefPubMed Kubba AK, Dallal H, Haydon GH, Hayes PC, Palmer KR: The effect of octreotide on gastroduodenal blood flow measured by laser Doppler flowmetry in rabbits and man. Am J Gastroenterol 1999, 94: 1077-1082. 10.1111/j.1572-0241.1999.929_b.xCrossRefPubMed
19.
Zurück zum Zitat Collins R, Langman M: Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage. Implications of randomized trials. N Engl J Med 1985, 313: 660-666.CrossRefPubMed Collins R, Langman M: Treatment with histamine H2 antagonists in acute upper gastrointestinal hemorrhage. Implications of randomized trials. N Engl J Med 1985, 313: 660-666.CrossRefPubMed
20.
Zurück zum Zitat Levine JE, Leontiadis GI, Sharma VK, Howden CW: Meta-analysis: the efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer. Aliment Pharmacol Ther 2002, 16: 1137-1142. 10.1046/j.1365-2036.2002.01274.xCrossRefPubMed Levine JE, Leontiadis GI, Sharma VK, Howden CW: Meta-analysis: the efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer. Aliment Pharmacol Ther 2002, 16: 1137-1142. 10.1046/j.1365-2036.2002.01274.xCrossRefPubMed
21.
Zurück zum Zitat Imperiale TF, Birgisson S: Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Ann Intern Med 1997, 127: 1062-1071.CrossRefPubMed Imperiale TF, Birgisson S: Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Ann Intern Med 1997, 127: 1062-1071.CrossRefPubMed
22.
Zurück zum Zitat Archimandritis A, Tsirantonaki M, Tryphonos M, Kourtesas D, Sougioultzis S, Papageorgiou A, Tzivras M: Ranitidine versus ranitidine plus octreotide in the treatment of acute non-variceal upper gastrointestinal bleeding: a prospective randomised study. Curr Med Res Opin 2000, 16: 178-183. 10.1185/030079900750120278CrossRefPubMed Archimandritis A, Tsirantonaki M, Tryphonos M, Kourtesas D, Sougioultzis S, Papageorgiou A, Tzivras M: Ranitidine versus ranitidine plus octreotide in the treatment of acute non-variceal upper gastrointestinal bleeding: a prospective randomised study. Curr Med Res Opin 2000, 16: 178-183. 10.1185/030079900750120278CrossRefPubMed
23.
Zurück zum Zitat Nikolopoulou VN, Thomopoulos KC, Katsakoulis EC, Vasilopoulos AG, Margaritis VG, Vagianos CE: The effect of octreotide as an adjunct treatment in active nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol 2004, 38: 243-247. 10.1097/00004836-200403000-00009CrossRefPubMed Nikolopoulou VN, Thomopoulos KC, Katsakoulis EC, Vasilopoulos AG, Margaritis VG, Vagianos CE: The effect of octreotide as an adjunct treatment in active nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol 2004, 38: 243-247. 10.1097/00004836-200403000-00009CrossRefPubMed
24.
Zurück zum Zitat Okan A, Simsek I, Akpinar H, Ellidokuz E, Sanul AR, Aksoz K: Somatostatin and ranitidine in the treatment of non-variceal upper gastrointestinal bleeding: a prospective, randomized, double-blind, controlled study. Hepatogastroenterology 2000, 47: 1325-1327.PubMed Okan A, Simsek I, Akpinar H, Ellidokuz E, Sanul AR, Aksoz K: Somatostatin and ranitidine in the treatment of non-variceal upper gastrointestinal bleeding: a prospective, randomized, double-blind, controlled study. Hepatogastroenterology 2000, 47: 1325-1327.PubMed
25.
Zurück zum Zitat van Rensburg CJ, Hartmann M, Thorpe A, Venter L, Theron I, Luhmann R, Wurst W: Intragastric pH during continuous infusion with pantoprazole in patients with bleeding peptic ulcer. Am J Gastroenterol 2003, 98: 2635-26341. 10.1111/j.1572-0241.2003.08723.xCrossRefPubMed van Rensburg CJ, Hartmann M, Thorpe A, Venter L, Theron I, Luhmann R, Wurst W: Intragastric pH during continuous infusion with pantoprazole in patients with bleeding peptic ulcer. Am J Gastroenterol 2003, 98: 2635-26341. 10.1111/j.1572-0241.2003.08723.xCrossRefPubMed
26.
Zurück zum Zitat Avgerinos A, Sgouros S, Viazis N, Vlachogiannakos J, Papaxoinis K, Bergele C, Sklavos P, Raptis SA: Somatostatin inhibits gastric acid secretion more effectively than pantoprazole in patients with peptic ulcer bleeding: a prospective, randomized, placebo-controlled trial. Scand J Gastroenterol 2005, 40: 515-522.CrossRefPubMed Avgerinos A, Sgouros S, Viazis N, Vlachogiannakos J, Papaxoinis K, Bergele C, Sklavos P, Raptis SA: Somatostatin inhibits gastric acid secretion more effectively than pantoprazole in patients with peptic ulcer bleeding: a prospective, randomized, placebo-controlled trial. Scand J Gastroenterol 2005, 40: 515-522.CrossRefPubMed
27.
Zurück zum Zitat Goletti O, Sidoti F, Lippolis PV, De Negri F, Cavina E: Omeprazole versus ranitidine plus somatostatin in the treatment of severe gastroduodenal bleeding: a prospective, randomized, controlled trial. Ital J Gastroenterol 1994, 26: 72-74.PubMed Goletti O, Sidoti F, Lippolis PV, De Negri F, Cavina E: Omeprazole versus ranitidine plus somatostatin in the treatment of severe gastroduodenal bleeding: a prospective, randomized, controlled trial. Ital J Gastroenterol 1994, 26: 72-74.PubMed
28.
Zurück zum Zitat Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB: The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 2004, 59: 788-794. 10.1016/S0016-5107(04)00181-6CrossRefPubMed Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB: The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 2004, 59: 788-794. 10.1016/S0016-5107(04)00181-6CrossRefPubMed
29.
Zurück zum Zitat Gotzsche PC, Gjorup I, Bonnen H, Brahe NE, Becker U, Burcharth F: Somatostatin v placebo in bleeding oesophageal varices: randomised trial and meta-analysis. BMJ 1995, 310: 1495-1498.PubMedCentralCrossRefPubMed Gotzsche PC, Gjorup I, Bonnen H, Brahe NE, Becker U, Burcharth F: Somatostatin v placebo in bleeding oesophageal varices: randomised trial and meta-analysis. BMJ 1995, 310: 1495-1498.PubMedCentralCrossRefPubMed
30.
Zurück zum Zitat Corley DA, Cello JP, Adkisson W, Ko WF, Kerlikowske K: Octreotide for acute esophageal variceal bleeding: a meta-analysis. Gastroenterology 2001, 120: 946-954. 10.1053/gast.2001.22451CrossRefPubMed Corley DA, Cello JP, Adkisson W, Ko WF, Kerlikowske K: Octreotide for acute esophageal variceal bleeding: a meta-analysis. Gastroenterology 2001, 120: 946-954. 10.1053/gast.2001.22451CrossRefPubMed
31.
Zurück zum Zitat Cales P, Masliah C, Bernard B, Garnier PP, Silvain C, Szostak-Talbodec N, Bronowicki JP, Ribard D, Botta-Fridlund D, Hillon P, et al.: Early administration of vapreotide for variceal bleeding in patients with cirrhosis. N Engl J Med 2001, 344: 23-28. 10.1056/NEJM200101043440104CrossRefPubMed Cales P, Masliah C, Bernard B, Garnier PP, Silvain C, Szostak-Talbodec N, Bronowicki JP, Ribard D, Botta-Fridlund D, Hillon P, et al.: Early administration of vapreotide for variceal bleeding in patients with cirrhosis. N Engl J Med 2001, 344: 23-28. 10.1056/NEJM200101043440104CrossRefPubMed
32.
Zurück zum Zitat Gotzsche PC, Hrobjartsson A: Somatostatin analogues for acute bleeding oesophageal varices. Cochrane Database Syst Rev 2005, (1):CD000193. Gotzsche PC, Hrobjartsson A: Somatostatin analogues for acute bleeding oesophageal varices. Cochrane Database Syst Rev 2005, (1):CD000193.
33.
Zurück zum Zitat Parente F, Anderloni A, Bargiggia S, Imbesi V, Trabucchi E, Baratti C, Gallus S, Porro GB: Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: a two-year survey. World J Gastroenterol 2005, 11: 7122-7130.CrossRefPubMed Parente F, Anderloni A, Bargiggia S, Imbesi V, Trabucchi E, Baratti C, Gallus S, Porro GB: Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: a two-year survey. World J Gastroenterol 2005, 11: 7122-7130.CrossRefPubMed
Metadaten
Titel
Pro/con debate: Octreotide has an important role in the treatment of gastrointestinal bleeding of unknown origin?
verfasst von
Yaseen Arabi
Bandar Al Knawy
Alan N Barkun
Marc Bardou
Publikationsdatum
01.08.2006
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 4/2006
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc4958

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