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Octreotide Enhances Portal Pressure Reduction Induced by Propranolol in Cirrhosis

A Randomized, Controlled Trial

Vorobioff, Julio D., M.D.1,2; Ferretti, Sebastián E., M.D.2; Zangroniz, Pedro, M.D.2; Gamen, Marcelo, M.D.1; Picabea, Eduardo, M.D.1; Bessone, Fernando O., M.D.2; Reggiardo, Virginia, M.D.2; Diez, Ana R., M.D.2; Tanno, Mario, M.D.2; Cuesta, Cristina, Ph.D.3; Tanno, Hugo E., M.D.2

American Journal of Gastroenterology: October 2007 - Volume 102 - Issue 10 - p 2206–2213
ORIGINAL CONTRIBUTION: LIVER AND BILIARY TRACT
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BACKGROUND In vitro, octreotide potentiates vasoconstriction in isolated, preconstricted, mesenteric arterial vessels. In cirrhotic patients, portal pressure (HVPG) reduction induced by propranolol is partly due to splanchnic vasoconstriction.

AIM To evaluate HVPG effects of octreotide administration in cirrhotic patients receiving long-term propranolol.

PATIENTS AND METHODS: A randomized, controlled trial. First study: a total of 28 patients were studied at baseline and 30 and 60 minutes after octreotide (200 μg) (N = 14) or placebo (N = 14) and then treated with propranolol for approximately 30 days (106 ± 5 mg/day). Second study: after baseline evaluation patients received octreotide or placebo as they were assigned to in the first study and measurements repeated 30 and 60 minutes later.

RESULTS In the first study baseline HVPG was 18.7 ± 0.9 mmHg and decreased to 17.1 ± 1.1 mmHg and 17.1 ± 1.0 mmHg (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Eight patients decreased their HVPG after octreotide. In the second study baseline HVPG was 15.6 ± 1.3 mmHg (P < 0.01 vs baseline HVPG in first study) and decreased to 14.1 ± 1.2 mmHg and 14.1 ± 1.3 mmHg (25.7 ± 5% lower than baseline HVPG in the first study, P < 0.01) (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Nine patients (2 responders/7 nonresponders to propranolol) decreased their HVPG after octreotide. Octreotide effects may be mediated by potentiation and additive mechanisms.

CONCLUSIONS Octreotide enhances HVPG reduction induced by propranolol in cirrhotic patients.

1Liver Unit and Hepatic Hemodynamic Laboratory, Sanatorio Parque; 2Hospital Provincial del Centenario; and 3University of Rosario School of Statistics, Rosario, Argentina

Reprint requests and correspondence: Julio Vorobioff, M.D., Liver Unit and Hepatic Hemodynamic Laboratory, Sanatorio Parque and Fundación Dr. J.R.Villavicencio, Morrison 8750, 2000 Rosario, Argentina.

CONFLICT OF INTEREST Specific author contributions: Julio D. Vorobioff, M.D., Sebastian Ferretti, M.D., Fernando Bessone, M.D., Virginia Reggiardo, M.D. Mario Tanno, M.D., and Hugo Tanno, M.D., are clinical hepatologists. Pedro Zangroniz, M.D., Marcelo Gamen, M.D., and Eduardo Picabea, M.D., are interventional radiologists. Ana R. Diez, M.D. is a clinician. Cristina Cuesta, Ph.D., is a statistician. She performed all statistical work. Clinical and radiological work was mainly performed by Julio D. Vorobioff and Sebastian E. Ferretti and by Pedro Zangroniz and Marcelo Gamen, respectively. All other colleagues were collaborators.

Financial support: None.

Potential competing interests: None.

Received January 1, 2007; accepted April 16, 2007.

© The American College of Gastroenterology 2007. All Rights Reserved.
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