Original Contribution
The American Journal of Gastroenterology (2005) 100, 624–630; doi:10.1111/j.1572-0241.2004.40665.x
Hemodynamic Effects of Terlipressin and High Somatostatin Dose during Acute Variceal Bleeding in Nonresponders to the Usual Somatostatin Dose
Grant support: This study has been supported in part by a grant from the Fundació Investigació Sant Pau and by a grant from the Instituto de Salud Carlos III (CO3/02).
Càndid Villanueva MD1, Montserrat Planella MD1, Carles Aracil MD1, Josep M López-Balaguer MD1, Begoña González MD1, Josep Miñana MD1 and Joaquim Balanzó MD1
1Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Correspondence: Càndid Villanueva, MD, Servei de Patologia Digestiva, Hospital de la Santa Creu i Sant Pau, Avgda. Sant Antoni Ma Claret, 167, Barcelona 08025, Spain
Received 1 July 2004; Revised 0000; Accepted 9 July 2004.
Abstract
OBJECTIVES:
High dose of somatostatin infusion achieves a greater reduction of hepatic venous pressure gradient (HVPG) than the usual dose, and terlipressin decreases HVPG through mechanisms other than somatostatin. Our aim was to assess the hemodynamic effects of terlipressin and high somatostatin dose during acute variceal bleeding in nonresponders to the usual somatostatin dose.
METHODS:
Hemodynamic studies were performed in 80 patients with cirrhosis and variceal bleeding during the first 3 days of admission. After baseline measurements, somatostatin was administered (250 
g/h with an initial bolus of 250 g). Patients were considered responders when the HVPG decreased by >10% from baseline (n = 31). Nonresponders were randomized under double-blind conditions to a control group (n = 7), or to receive terlipressin (2 mg IV bolus, n = 22), or high dose of somatostatin (500 g/h, n = 20). Final measurements were obtained 30 min later.
RESULTS:
Terlipressin caused a decrease in HVPG (from 22.2 
5 to 19.1 5.2, p < 0.01) and heart rate (p < 0.01), while mean arterial pressure increased (p < 0.01). High somatostatin dose also reduced HVPG (from 21.8 3.4 to 19.6 3.1, p < 0.01), although this decrease was more pronounced with terlipressin (15% 9%vs 10% 6% from baseline, p= 0.05). Both terlipressin and high somatostatin dose achieved a significantly higher rate of response than that in the control group. A decrease in HVPG >20% was observed in 36% of cases with terlipressin versus 5% with high somatostatin dose (p= 0.02).
CONCLUSIONS:
In nonresponders to usual somatostatin dose, both terlipressin and high-dose of somatostatin infusion significantly decreased HVPG and increased the rate of hemodynamic responders. Such effects were greater with terlipressin. Both treatments may be an alternative when standard somatostatin fails.
