© 2011, INASL 13 CIRRHOSIS AND ITS COMPLICATIONS Comparative Study of Terlipressin, Somatostatin and Octreotide in Acute Esophageal Variceal Bleed: A Prospective Randomized Study CK Adarsh, KS Prasanna, H Devarbhavi, D Karanth, Mallikarjuna, B Girisha Department of Gastroenterology, St. Johns Medical College Hospital, Bangalore Background and Aims: Terlipressin, somatostatin and octreotide are known to reduce portal pressures and hence used as adjuvant therapy to endoscopic management of acute variceal bleed. However head to head comparison of above drugs has not been carried out. We evaluated the efficacy of these drugs with respect to control of acute variceal bleed, rebleed and mortality at 6 weeks. Methods: A total of 210 cirrhotic patients with esophageal variceal bleed were randomized to receive either somatostatin (group A = 73), terlipressin (group B = 69), or octreotide (group C = 68) prior to the endoscopic therapy. The drug was continued for 48 hours after endotherapy. Failure to control bleeding and rebleeding were defined according to Baveno-IV criteria. Results: Baseline characteristics of the three groups were comparable with respect to age, gender, etiology, Child-Pugh class, MELD score, duration of hospital stay, serum creatinine, serum sodium, active bleed seen during endoscopy and ascites. No significant difference was seen in failure to control bleed (group A vs. group B vs. group C: 15.1% vs. 18.8% vs. 25% p > 0.05), in hospital mortality (2.7% vs. 2.9% vs. 2.9%), rebleed at 6 weeks (13.7% vs. 15.9% vs. 26.5%, p > 0.05) and mortality at 6 weeks (13.7% vs. 10.1% vs. 17.6%, p > 0.05) among the three groups. On multivariate analysis, presence of portal hypertensive gastropathy, number of units of blood transfused and serum creatinine levels were independent predictors of failure to control bleed. Etiology of liver disease (ethanol and hepatitis C) and active bleed during endoscopy were independent predictors of mortality at 6 weeks. Child-Pugh class and serum sodium levels were independent predictors of rebleed at 6 weeks. Conclusion: The efficacy of somatostatin, terlipressin and octreotide as an adjuvant therapy for the control of acute esophageal variceal bleed, in-hospital survival, rebleed at 6 weeks and mortality at 6 weeks was comparable. Conflict of Interest: None A Study on Seroprevalence of Hepatitis A Antibody (IgG Anti-HAV) in Cirrhotic Patients DJ Payeng*, AK Das** *PGT, **Professor, Department of Medicine, Assam Medical College, Dibrugarh, Assam Background: Hepatitis A virus (HAV) vaccination is recommended in worldwide for cirrhotic patients to prevent decompensation due to superinfection with HAV. The prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among cirrhotic patients may be high and, therefore, vaccination may not be needed. However, little data are available on the prevalence of HAV antibody among patients with chronic liver disease in India, especially in North East part of our country. Aims: To evaluate the seroprevalence of Hepatitis A virus anti-body (IgG anti-HAV) in cirrhotic patients and necessity of uniform vaccination against hepatitis A in these patients. Methods: Eighty cirrhotic patients attended in Department of Medicine, Assam Medical College and Hospital, during the period of 1 year were tested for the presence of IgG anti-HAV antibody (using a commercial ELISA kit). In addition, 100 apparently healthy subjects without liver disease were tested for the presence of IgG anti-HAV antibody in their sera. Results: Mean age of these cirrhotics and healthy group was 48.07 and 33.08 years and 67 (84%) and 70 (70%) of them were males, respectively. The seroprevalence of anti-HAV in two groups were 95% and 89%, respectively. In apparently healthy group, lower seroprevalence was observed in young adult (70%) than the rest. The prevalence of anti-HAV positivity was similar among patients with various etiologies. Conclusion: As there is a very high prevalence of pre-existing antibodies in these patients, uniform vaccination is not required. However those with negative anti-HAV are increased risk especially in young adult for developing fulminant hepatic failure should be vaccinated rendering cost effectiveness of vaccine. Conflict of Interest: None 03_JCEH-Abstract.indd 13 3/18/2011 11:13:03 AM