The effect of the combination of octreotide and metoclopramide on azygos blood flow in cirrhotic patients with portal hypertension.
European Journal of Gastroenterology and Hepatology
839 - 843.
Objective: To determine whether the administration of octreotide followed by metoclopramide would result in a further reduction in azygos blood flow. Design: Prospective randomized double-blind investigation. Setting: Tertiary referral liver unit. Patients: Seventeen patients with cirrhosis and endoscopically proven portal hypertension. Interventions: Each patient received a bolus dose of octreotide (50 μg i.v.) followed by a continuous i.v. infusion (50 μg/h) and was then given metoclopramide 20 mg i.v. or placebo in a random blinded order. The hepatic and azygos veins were catheterized. Hepatic venous pressures were measured and azygos blood flow was estimated using a thermodilution technique. Main outcome measures: Changes in the azygos blood flow and portal venous pressures. Results: Octreotide significantly reduced mean azygos blood flow from 650ml/min ± 79 SEM at baseline to 500 ml/min ± 76 SEM at 10 min (P < 0.05) and to 482ml/min ± 70 SEM at 20min (P < 0.05). Azygos blood flow rose subsequently despite a continuous intravenous infusion of octreotide and the administration of metoclopramide and placebo. Administration of octreotide was also associated with significant increases in free hepatic venous pressure (5.1 ± 0.9 mmHg versus 6.6 ± 1.0 mmHg; P < 0.05) and a significant decrease in hepatic venous pressure gradient (18.6 ± 1.4 versus 17.5 ± 1.5 mmHg; P < 0.05) 20min after the start of octreotide administration. Conclusions: In this study, the addition of metoclopramide to octreotide did not result in an additional fall in azygos blood flow in patients with cirrhosis and portal hypertension.
|Title:||The effect of the combination of octreotide and metoclopramide on azygos blood flow in cirrhotic patients with portal hypertension|
Archive Staff Only