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Octreotide therapy for control of acute gastrointestinal bleeding in children
Y Eroglu1, K M Emerick, P F Whitingon
1Department of Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614, USA.
Insights
Octreotide effectively controlled acute gastrointestinal bleeding in children with portal hypertension, though rebleeding and mortality remain concerns. Its efficacy in non-portal hypertension bleeding requires further study.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Hepatology
Background:
- Gastrointestinal bleeding (GIB) in children can be severe, particularly in those with portal hypertension.
- Octreotide, a somatostatin analog, is used to reduce splanchnic blood flow and control bleeding.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of octreotide in pediatric patients experiencing gastrointestinal bleeding, with or without portal hypertension.
Main Methods:
- Retrospective review of medical charts for children receiving continuous octreotide infusion for GIB between January 1995 and December 2000.
- Analysis of bleeding cessation, rebleeding rates, and mortality in relation to portal hypertension and intrinsic liver disease.
Main Results:
- In children with portal hypertension (n=21), octreotide achieved bleeding cessation in 71% of episodes, with a 52% rebleeding rate and 19% mortality.
- In children without portal hypertension (n=12), 50% experienced bleeding resolution during infusion, with a 29% rebleeding rate and 50% mortality.
- No significant differences in outcomes were observed between patients with or without intrinsic liver disease. No major adverse events were reported.
Conclusions:
- Octreotide demonstrates a high rate of bleeding control in acute pediatric GIB associated with portal hypertension.
- The clinical role of octreotide in pediatric GIB unrelated to portal hypertension is less definitive.
- Further controlled studies are necessary to fully elucidate the clinical effects of octreotide in pediatric GIB.
Objectives:
To evaluate the outcomes of octreotide use in children with gastrointestinal bleeding with or without portal hypertension.
Methods:
The medical charts of children who received continuous octreotide infusion for the indication of gastrointestinal bleeding from January 1995 to December 2000 were retrospectively reviewed.
Results:
Twenty-one children with portal hypertension received octreotide infusions (1-2 microg/kg/h) during 35 gastrointestinal bleeding episodes. The duration of infusion ranged from 19 hours to 7 days. Bleeding ceased in 71% of children. Post-treatment rebleeding occurred in 52%, and the mortality was 19%. Response to octreotide, rebleeding, and mortality did not differ significantly between patients with or without intrinsic liver disease. Twelve children with gastrointestinal bleeding unrelated to portal hypertension received octreotide during 14 episodes. The duration of octreotide ranged from 3 hours to 36 days. Fifty percent of children had resolution of bleeding during the infusion. Post-treatment rebleeding occurred in 29%, and the mortality was 50%. No major adverse events were observed in either group.
Conclusions:
A high rate of bleeding control was achieved with octreotide during acute gastrointestinal bleeding in children with portal hypertension. However, controlled studies are needed for more definitive description of its clinical effects. The role of octreotide is less clear in gastrointestinal bleeding unrelated to portal hypertension.
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