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Terlipressin or somatostatin for the treatment of bleeding oesophageal varices
  1. Russel Boyd, Consultant,
  2. John Butler, Consultant

    Abstract

    A short cut review was carried out to establish whether terlipressin or somatostatin is more effective at reducing acute bleeding in adults with known oesophageal varices. Altogether 170 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Russel Boyd, ConsultantChecked by John Butler, Consultant

    Clinical scenario

    A 55 year old man presents to the Emergency Department with massive haematemesis. He has known oesophageal varices. He is tachycardic, peripherally shut down and continues to actively vomit fresh blood. You wonder if pharmacological treatment with terlipressin or somatostatin will be effective in reducing the bleeding.

    Three part question

    In [adults with known varices] is [terlipressin or somatostatin] more effective at [reducing acute bleeding]?

    Search strategy

    Medline OVID 1966–2005 February Week 1 and Embase OVID 1980–2004 Week 7: [(exp Gastrointestinal Hemorrhage/OR exp “Esophageal and Gastric Varices”/or oesophageal varices.mp.)] AND [(exp SOMATOSTATIN/AND terlipressin.mp. OR glypressin.mp. OR terlypressin.mp.)] LIMIT to humans and Eng Lang.

    Search outcome

    Altogether 170 papers were identified of which four were relevant to the clinical question. These four papers are shown in table 1.

    Table 1

    Comment(s)

    Four randomised controlled studies exist in this area. No significant difference in rates of cessation of bleeding were found between patients treated with either terlipressin or somatostatin.

    CLINICAL BOTTOM LINE

    There appears to be no significant difference between terlipressin and somatostatin in their ability to control bleeding. The logistical advantage of four hourly bolus administration of terlipressin over the need for continuous infusions of somatostatin and the lower cost of terlipressin will be relevant when choosing between them.

    Report by Russel Boyd, ConsultantChecked by John Butler, Consultant

    References

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