Effect of bolus injection and continuous infusion of somatostatin on gastric perfusion in cirrhotic patients with portal-hypertensive gastropathy

Abstract

Gastric perfusion has been found to be increased in cirrhotic patients with portal-hypertensive gastropathy. This phenomenon may contribute to gastric bleeding from these lesions. Therefore drugs reducing gastric mucosal perfusion may be beneficial in the treatment of bleeding portal-hypertensive gastropathy. In this study, gastric mucosal perfusion was assessed, by means of laser-Doppler flowmetry and reflectance spectrophotometry, in 36 cirrhotic patients with portal-hypertensive gastropathy in basal conditions and after double-blind administration of placebo or somatostatin. Intravenous bolus injection of 250 μg somatostatin induced a rapid, marked decrease in gastric perfusion (−31.6% ± 7.9%, p<0.05), as assessed on laser-Doppler flowmetry, that lasted for only 6 min. Changes in the hemoglobin content of the gastric mucosa paralleled those of laser-Doppler signal. The oxygen content of the gastric mucosa was mildly reduced (−6.9% ± 1.1%, p<0.05). When the bolus injection was followed by a continuous infusion of somatostatin, the reduction in gastric perfusion, as assessed by means of laser-Doppler flowmetry, was maintained, although the magnitude of the reduction (−17% ± 7%) was significantly lower than that observed immediately after the bolus (p<0.05); the hemoglobin content of the gastric mucosa was also significantly reduced (−8% ± 1%), but no changes were observed in the oxygen content. Placebo administration had no effect on any of these parameters. We conclude that the increased gastric perfusion in cirrhotic patients with portal-hypertensive gastropathy can be effectively decreased by somatostatin administration. (Hepatology 1994;20:336–341.)