OCTREOTIDE PREVENTS POSTPRANDIAL SPLANCHNIC HYPEREMIA IN PATIENTS WITH PORTAL-HYPERTENSION

An increase in splanchnic blood flow is a physiological response to fo od intake. In patients with cirrhosis whose hepatic vascular resistanc e is already high, this increase in flow leads to marked increases in portal pressure. This study investigates whether octreotide prevents t he increases in hepatic how and portal pressure that follow the ingest ion of a meal in patients with cirrhosis. Twenty-two patients with cir rhosis and portal hypertension were randomized to receive a mixed liqu id meal (520 kcal) plus a single subcutaneous injection of either plac ebo or octreotide (200 mu g). In the placebo group the ingestion of a meal was followed by an increase in the hepatic venous pressure gradie nt (+19.4 +/- 4.3%, p<0.01) and hepatic blood flow (+38.2 +/- 14.6%, p <0.05) at 30 min. In contrast, in the octreotide group eating caused n o significant change in the hepatic venous pressure gradient (-2.8 +/- 3.6%, NS), while hepatic flow was decreased (-6.08 +/- 5.4%, p<0.05). Octreotide blunted the postprandial increase in serum insulin and glu cagon levels observed in the placebo group. In conclusion, in patients with cirrhosis and portal hypertension, octreotide prevents the postp randial increase in hepatic blood flow, and consequently also in porta l pressure. These findings suggest that this drug could play a role in the longterm management of portal hypertension. (C) Journal of Hepato logy.