Terlipressin at esophageal varicose bleeding at liver cirrhosis with portal hypertension syndrome

Abstract

Aim of investigation. To compare efficacy of vasoactive therapy by terlipressin and octreotide at bleeding from varicose veins of the esophagus in patients with liver cirrhosis.Material and methods. Investigation was based on the retrospective analysis of results of treatment of 72 patients with liver cirrhosis and portal hypertension syndrome. According to Child-Pugh criteria patients were distributed as follows: class A – 12 (16,7%), class B – 41 (56,9%), class C – 19 (26,4%). Terlipressin (main group, n=32) and octreotide (control group, n=40) were used as vasoactive drugs. Both groups have been comparable by age, gender, etiology of cirrhosis, degree of varicose dilation of esophageal veins and severity of liver dysfunction.Results. Terlipressin prescription reduced rate of bleeding and promoted achievement of temporary hemostasis in 71,9% of patients, while application of octreotide – only in 55% of cases. Early relapse of esophageal bleeding has developed in the main group in 6,3% of cases, in control – in 12,5% (р<0,05). Terlipressin injection was accompanied by significant decrease both linear, and volume velocity of portal blood flow on average by 41,6±9,7% (р=0,038) and 33,9±5,8% (р=0,024), respectively. This effect was observed for over 60 mines from the moment of injection. After injection of octreotide decrease of main velocity features of portal blood flow was marked as well: linear speed has decreased by 34,1±10,3% (р=0,030), and volume – by 28,6±9,8% (р=0,041). However in 60 min after injection of octreotide both parameters returned almost to baseline level (р>0,05). In both groups injection of studied agents was accompanied by change of parameters of central hemodynamics. Though the level of mean blood pressure and heart rate decreased, only reduction of cardiac output in the main group significantly differed from reference values.Conclusion. Terlipressin has more significant effect on portal hemodynamics and possesses the greater efficacy in comparison to octreotide at bleeding of portal origin.

Keywords

• portal hypertension syndrome
• bleeding from varicose esophageal veins
• vasoactive therapy
• terlipressin
• octreotide