What is the role of Octreotide (Somatostatin analogue) in managing gastrointestinal (GI) bleeding?

From the Guidelines

Octreotide is not recommended for routine management of acute nonvariceal upper GI bleeding, but it may be useful in patients with variceal bleeding or those awaiting endoscopy, surgery, or for whom surgery is contraindicated, due to its favorable safety profile 1.

Key Points

• The use of octreotide in managing gastrointestinal (GI) bleeding is generally not recommended for routine management of acute nonvariceal upper GI bleeding, as evidenced by studies from 2003 1.
• However, octreotide may still have a role in specific situations, such as in patients with variceal bleeding, where it is considered the vasoactive drug of choice based on its safety profile 1.
• For patients with variceal bleeding, the recommended dose of octreotide is an initial IV bolus of 50 micrograms, which can be repeated in the first hour if ongoing bleeding, followed by a continuous IV infusion of 50 mg/hr for 2-5 days 1.
• Octreotide works by reducing splanchnic blood flow, decreasing portal pressure, and inhibiting the release of vasodilatory hormones, which helps control bleeding, particularly from varices or other sources in the GI tract.
• Common side effects of octreotide include nausea, abdominal discomfort, and hyperglycemia, so blood glucose monitoring is advisable.
• Octreotide should be used as part of a comprehensive management approach that may include endoscopic therapy, correction of coagulopathy, and other supportive measures depending on the bleeding source.

Management Approach

• Endoscopy should be performed as soon as possible, and not more than 12 hours after presentation, to confirm the source of bleeding and to perform necessary interventions like EVL for variceal bleeding 1.
• For high-risk patients, early TIPS (within 72 hours of admission) may be considered to reduce treatment failure and mortality rates, but this should be done with careful selection and consideration of the patient's condition 1.
• In cases of refractory bleeding, bridge therapies such as balloon tamponade or endoscopically placed self-expandable metal stents may be necessary until a more definitive therapy can be performed 1.

From the FDA Drug Label

Octreotide acetate injection exerts pharmacologic actions similar to the natural hormone, somatostatin. It is an even more potent inhibitor of growth hormone (GH), glucagon, and insulin than somatostatin Like somatostatin, it also suppresses luteinizing hormone (LH) response to gonadotropin releasing hormone (GnRH), decreases splanchnic blood flow, and inhibits release of serotonin, gastrin, vasoactive intestinal peptide (VIP), secretin, motilin, and pancreatic polypeptide

The role of Octreotide in managing gastrointestinal (GI) bleeding is related to its ability to decrease splanchnic blood flow. This action can help reduce blood flow to the GI tract, which may be beneficial in managing GI bleeding. However, the label does not provide direct information on the use of octreotide for GI bleeding. 2

From the Research

Role of Octreotide in Managing GI Bleeding

• Octreotide, a somatostatin analogue, is used in the management of gastrointestinal (GI) bleeding, particularly in cases of acute variceal bleeding 3, 4, 5, 6, 7.
• The drug has been shown to be effective in controlling initial hemorrhage and preventing reoccurrence of bleeding in patients with esophageal varices 5, 7.
• Octreotide is often used in combination with endoscopic variceal ligation (EVL) for the treatment of acute esophageal variceal bleeding, and has been found to be equally safe and effective as terlipressin when used in this manner 6.
• The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of vasoactive agents such as octreotide, terlipressin, or somatostatin in patients with suspected acute variceal bleeding, and suggests that these agents be initiated at the time of presentation and continued for up to 5 days 4.
• Octreotide has also been found to have a beneficial effect on portal hemodynamics in cirrhotic patients, and is considered a less expensive option than somatostatin for the treatment of variceal bleeding 7.

Comparison with Other Treatments

• Studies have compared the efficacy of octreotide with other treatments, such as terlipressin and vasopressin, and have found that octreotide is effective in controlling acute variceal bleeding with fewer side effects than vasopressin 5.
• Octreotide has also been compared with terlipressin in combination with EVL, and has been found to be equally effective in controlling bleeding and preventing reoccurrence 6.
• The ESGE guidelines recommend the use of nonselective beta blockers (NSBBs) in combination with endoscopic therapy for secondary prophylaxis in patients with acute variceal bleeding, and suggest that octreotide may be used as an adjunct to endoscopic treatment in patients with high-risk variceal bleeding 4.

Clinical Significance

• The use of octreotide in the management of GI bleeding has been found to be clinically significant, particularly in patients with acute variceal bleeding 3, 4, 5, 6, 7.
• The drug has been shown to be effective in reducing mortality and rebleeding rates in patients with esophageal varices, and is considered a valuable adjunct to endoscopic treatment in patients with high-risk variceal bleeding 4, 6.
• Overall, the evidence suggests that octreotide is a safe and effective treatment option for patients with acute variceal bleeding, and should be considered as part of a comprehensive treatment plan for these patients 3, 4, 5, 6, 7.