tailieunhanh - Emergencies and Complications in Gastroenterology - part 2

Tuy nhiên, dữ liệu thử nghiệm là mâu thuẫn nhau. Meta phân tích đã cho thấy kiểm soát tốt hơn xuất huyết so với vasopressin [38]. Một phân tích meta-không cho thấy hiệu quả tốt hơn đáng kể so với giả dược [39]. Nghiên cứu nhỏ hơn, tuy nhiên, tìm thấy một hiệu quả tương tự so với liệu pháp xơ hoá | significantly decreases not only the portal pressure but also the gastric mucosa blood flow GMBF 37 which is potentially important in the bleeding from portal hypertensive gastropathy. However trial data are conflicting. Meta-analyses have shown better control of bleeding compared with vasopressin 38 . A meta-analysis did not show significantly better efficacy in comparison to placebo 39 . Smaller studies however found a similar efficacy compared to sclerotherapy 40 terlipressin 31 and found a lesser need for blood transfusions and other urgent therapies 41 . Octreotide Octreotide is a synthetic octapeptide derivate of somatostatin first described in 1982. Besides octreotide more than 20 synthetic analogues of the somatostatin are known. Lanreotide was tested mainly in animal models. Vapreotide was better in comparison with placebo and was proved to increase the efficacy of endoscopic treatment in variceal bleeding in humans 42 . None of these other analogues are currently used in common clinical practice. Octreotide has a similar pharmacological effect as somatostatin. The differences are dependent on its binding to three out of five somatostatin receptors. In comparison to somatostatin its advantages are its longer half-time 90-120 min and especially longer pharmacological action 8-12 h . Octreotide as well as somatostatin decreases significantly the portal pressure in animals 43 but its influence on hemodynamics in cirrhotics including decrease of the portal pressure was not significantly proved 44 . It probably also influences the mesenteric circulation 45 . Meta-analysis studies using octreotide or somatostatin have shown a lower rate of complications and a similar effect as sclerotherapy or balloon tamponade 46 . A newer meta-analysis comparing octreotide to other medical therapy and placebo has shown a better effect of the octreotide on the bleeding control compared to placebo and other drugs and side effects comparable to placebo or no treatment 47 . The .