Haemodynamic effects of propranolol, octreotide and their combination during fasting and post-prandial splanchnic hyperaemia in patients with cirrhosis

C. Sabbà, P. Buonamico, G. Vendemiale, E. Berardi, G. Antonica, V. Palmieri, C. Merkel, G. Palasciano

Research output: Contribution to journalArticle

Abstract

Background/aims. This double-blind study was designed to evaluate the haemodynamic effect of two drugs, propranolol and octreotide, and their combination in patients with cirrhosis. Methods. Fifteen patients with cirrhosis were randomly assigned to two groups receiving either octreotide subcutaneously at 100 μg ('octreotide' group, n = 9) or propranolol orally at 40 mg followed by a subcutaneous dose of octreotide (100 μg) after 1 h ('propranolol + octreotide' group, n = 6); then, after 30 min, a standard meal was administered to both groups. The hepatic vein pressure gradient by hepatic vein catheterization, portal and superior mesenteric artery blood flow velocity, superior mesenteric artery pulsatility index by the echo-Doppler duplex system were recorded at baseline, 1 h after propranolol in the 'propranolol + octreotide' group, and in both groups 30 min after octreotide and 30 min after meal. Results. At fast, propranolol was more active in decreasing portal pressure (from 16 ± 2.2 to 12.7 ± 3.8 mmHg, -20%, P <0.05) as compared to octreotide (from 18.6 ± 4.8 to 16.6 ± 4.3 mmHg, -11%, P <0.05). Conversely, octreotide was more active on the mean blood flow velocity of superior mesenteric artery (from 22.8 ± 5 to 19 ± 4.5 cm/s, - 17%; P <0.05). Octreotide administration in patients receiving β-blockers showed, also, a trend to increase the mesenteric vascular resistances (pulsatility index from 3.14 ± 0.69 to 3.68 ± 1.29, +17%, not significant (NS)) which had not been affected by previous treatment with propranolol. After the meal, a reduction of the expected hyperaemic response occurred in both groups. Conclusions. The combined acute haemodynamic effect of this association suggests the possible combination of these two drugs in critical situations, such as variceal bleeding in patients receiving β-blockers. The simultaneous use of echo-Doppler and hepatic vein catheterization permitted us a more complete analysis of the acute haemodynamic events.

Original languageEnglish
Pages (from-to)163-169
Number of pages7
JournalEuropean Journal of Gastroenterology and Hepatology
Volume13
Issue number2
DOIs
Publication statusPublished - 2001

Keywords

  • Cirrhosis
  • Doppler ultrasound
  • Octreotide
  • Portal hypertension
  • Propranolol

ASJC Scopus subject areas

  • Gastroenterology

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