SOMATOSTATIN REDUCES GASTRIC-MUCOSAL BLOOD-FLOW IN PATIENTS WITH PORTAL HYPERTENSIVE GASTROPATHY - A RANDOMIZED, DOUBLE-BLIND CROSSOVER STUDY

Agents which decrease gastric mucosal blood flow (GMBF) are postulated to have beneficial effects in arresting gastrointestinal bleeding in cirrhotic patients with portal hypertension. Our objective was to test the hypothesis that in a dose that significantly lowers wedged hepati c venous pressure (WHVP), a bolus injection of somatostatin will signi ficantly decrease GMBF in patients with portal hypertensive gastropath y (PHG). In this placebo-controlled, double-blind, crossover study, 20 cirrhotic patients with PHG were randomly assigned to receive either somatostatin followed by placebo (Group A) or placebo followed by soma tostatin (Group B). Wedged hepatic venous pressure was monitored. GMBF in the antrum and corpus was assessed by reflectance spectrophotometr y. Indices of hemoglobin concentration (IHb) and indices of oxygen con tent (ISO2) were recorded. Nine patients were assigned to Group A, and 11 to Group B. Mild PHG was seen in 16 patients, and severe PHG in 4 patients. Baseline WHVP, IHb, and ISO2 were similar in both treatment groups. Wedged hepatic venous pressure (WHVP) was significantly lowere d [median, 17.6%; interquartile range (-27.0, -12.6%); P = 0.0008] aft er a 250-mu g bolus injection of somatostatin. This dose of somatostat in significantly reduced IHb both in the antrum [-10.2% (-23.3, 0.4%)] and in the corpus [-5.8% (-16.6, 5.6%)] compared to placebo (P = 0.02 and 0.04, respectively). Intravenous bolus injection of 250 mu g soma tostatin significantly reduces WHVP and GMBF in patients with PHG. Whe ther this ability to decrease the GMBF in PHG makes somatostatin an ef fective treatment in acute gastrointestinal bleeding in PHG deserves t o be studied.