1
|
Khedr A, Mahmoud EE, Attallah N, Mir M, Boike S, Rauf I, Jama AB, Mushtaq H, Surani S, Khan SA. Role of octreotide in small bowel bleeding. World J Clin Cases 2022; 10:9192-9206. [PMID: 36159407 PMCID: PMC9477697 DOI: 10.12998/wjcc.v10.i26.9192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/30/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal bleeding accounts for a drastic negative impact on the quality of the patients’ lives as it requires multiple diagnostic and therapeutic interventions to identify the source of the bleeding. Small bowel bleeding is the least common cause of gastrointestinal bleeding. However, it is responsible for the majority of complaints from patients with persisting or recurring bleeding where the primary source of bleeding cannot be identified despite investigation. A somatostatin analog known as octreotide is among the medical treatment modalities currently used to manage small bowel bleeding. This medication helps control symptoms of gastrointestinal bleeding by augmenting platelet aggregation, decreasing splanchnic blood flow, and antagonizing angiogenesis. In this review article, we will highlight the clinical efficacy of octreotide in small bowel bleeding and its subsequent effect on morbidity and mortality.
Collapse
Affiliation(s)
- Anwar Khedr
- Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | | | - Noura Attallah
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Mikael Mir
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Sydney Boike
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Ibtisam Rauf
- Department of Medicine, St. George School of Medicine, Grenada, West Indies
| | - Abbas B Jama
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Hisham Mushtaq
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, United States
| | - Syed A Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| |
Collapse
|
2
|
Ali AA, Oye M, Streit S, Foldy S, Aung W, Schey R. A Bleeding GIST Managed with Octreotide. Am J Med 2021; 134:e435-e436. [PMID: 33621537 DOI: 10.1016/j.amjmed.2021.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Aleem Azal Ali
- Internal Medicine, College of Medicine, University of Florida, Jacksonville.
| | - Monique Oye
- Internal Medicine, College of Medicine, University of Florida, Jacksonville
| | - Spencer Streit
- Internal Medicine, College of Medicine, University of Florida, Jacksonville
| | - Samuel Foldy
- Internal Medicine, College of Medicine, University of Florida, Jacksonville
| | - Win Aung
- Internal Medicine, College of Medicine, University of Florida, Jacksonville
| | - Ron Schey
- Department of Internal Medicine, Division of Gastroenterology/Hepatology, College of Medicine, University of Florida, Jacksonville
| |
Collapse
|
3
|
Thalidomide Use Reduces Risk of Refractory Gastrointestinal Bleeding in Patients with Continuous Flow Left Ventricular Assist Devices. ASAIO J 2021; 66:645-651. [PMID: 31425265 DOI: 10.1097/mat.0000000000001054] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal (GI) bleeding is a common complication seen in patients with implanted continuous flow left ventricular assist devices (CF-LVAD), often attributed to arteriovenous malformations (AVMs). Whether thalidomide reduces recurrent GI bleeding risk in CF-LVAD patients has been incompletely evaluated. We conducted a retrospective review of all CF-LVAD patients at our institution with GI bleeding from AVMs who had a trial both off and on thalidomide. The primary endpoint was time to rebleed, while secondary endpoints included overall GI bleeding events, packed red blood cell (PRBC) transfusion requirements, and adverse events related to thalidomide. We report on 24 patients with recurrent AVM-associated GI bleeding who met criteria for and received thalidomide therapy, of which 17 had sufficient follow-up to be ultimately included for final analysis. We found the risk of rebleeding was significantly reduced in those on thalidomide therapy versus off (hazard ratio = 0.23, p = 0.022). The median number of GI bleeds per year was reduced from 4.6 to 0.4 (p = 0.0008) and the PRBC requirement was lower (36.1 vs. 0.9 units per year, p = 0.004) in those on thalidomide therapy. The adverse event rate with thalidomide was 59%, with symptoms resolution in most following dose reduction without increased bleeding. Thalidomide reduced the risk of AVM-associated GI rebleeding, number of bleeding events, and PRBC requirements in CF-LVAD patients. When initiating therapy, potential side effects and overall clinical context should be considered.
Collapse
|
4
|
Riha HM, Wilkinson R, Twilla J, Harris LJ, Kimmons LA, Kocak M, Van Berkel MA. Octreotide Added to a Proton Pump Inhibitor Versus a Proton Pump Inhibitor Alone in Nonvariceal Upper-Gastrointestinal Bleeds. Ann Pharmacother 2019; 53:794-800. [PMID: 30803243 DOI: 10.1177/1060028019833696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Literature indicating clinically relevant benefits of an adjunctive somatostatin analog to standard therapies in nonvariceal upper-gastrointestinal bleeding (NVUGIB) is lacking. Objective: The primary objective of this study was to find the association between outcomes in patients with NVUGIB treated with octreotide and a proton pump inhibitor (PPI; combination group) compared with those treated with a PPI alone. Methods: We conducted a retrospective cohort study of adults admitted within a 5-hospital health care system with a NVUGIB treated with a PPI continuous infusion with or without an octreotide infusion. Notable exclusion criteria included varices, history of cirrhosis without endoscopy, or active gastrointestinal cancer. The primary outcome was association of combination treatment versus PPI alone with hospital length of stay (LOS). Results: A total of 180 patients were included (combination group: n = 90; PPI: n = 90). In univariate analyses, the median hospital and intensive care unit (ICU) LOS in the combination group versus PPI was 6.1 versus 4.9 days (P = 0.25) and 2.3 versus 1.9 days (P = 0.24), and rebleeding and mortality occurred in 9% versus 12% (P = 0.63) and 6.7% versus 5.6% (P = 1.00) of patients. Median units of packed red blood cells in the combination therapy versus PPI group was 3 vs 2 units (P = 0.43). After propensity score adjustment in multivariable analyses, hospital and ICU LOS, rebleeding, and mortality all remained nonsignificant. Conclusion and Relevance: Our study observed no difference in clinical end points. This suggests that octreotide provides no additional major clinical benefit in NVUGIB, and PPI therapy alone may be sufficient.
Collapse
Affiliation(s)
- Heidi M Riha
- 1 Methodist University Hospital, Memphis, TN, USA
| | - Rachel Wilkinson
- 2 Fort Sanders Regional Medical Center, Knoxville, TN, USA.,3 University of Tennessee Health Sciences Center, Knoxville, TN, USA
| | - Jennifer Twilla
- 1 Methodist University Hospital, Memphis, TN, USA.,4 University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | - Lauren A Kimmons
- 1 Methodist University Hospital, Memphis, TN, USA.,4 University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Mehmet Kocak
- 4 University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Megan A Van Berkel
- 5 Erlanger Health System, Chattanooga, TN, USA.,6 University of Tennessee Health Sciences Center, Chattanooga, TN, USA
| |
Collapse
|
5
|
Fortinsky KJ, Bardou M, Barkun AN. Role of Medical Therapy for Nonvariceal Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2015; 25:463-78. [PMID: 26142032 DOI: 10.1016/j.giec.2015.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nonvariceal upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality worldwide. Mortality from UGIB has remained 5-10% over the past decade. This article presents current evidence-based recommendations for the medical management of UGIB. Preendoscopic management includes initial resuscitation, risk stratification, appropriate use of blood products, and consideration of nasogastric tube insertion, erythromycin, and proton pump inhibitor therapy. The use of postendoscopic intravenous proton pump inhibitors is strongly recommended for certain patient populations. Postendoscopic management also includes the diagnosis and treatment of Helicobacter pylori, appropriate use of proton pump inhibitors and iron replacement therapy.
Collapse
Affiliation(s)
- Kyle J Fortinsky
- Department of Medicine, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Marc Bardou
- Gastroenterology Department & Centre d'Investigations Clinique CIC1432, CHU de Dijon, 14 rue Gaffarel BP77908, Dijon, Cedex 21079, France.
| | - Alan N Barkun
- Gastroenterology Department, McGill University Health Centre, Montreal General Hospital Site, Room D7-346, 1650 Cedar Avenue, Montréal, Québec H3G 1A4, Canada
| |
Collapse
|
6
|
Upper gastrointestinal bleeding: patient presentation, risk stratification, and early management. Gastroenterol Clin North Am 2014; 43:665-75. [PMID: 25440918 DOI: 10.1016/j.gtc.2014.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The established quality indicators for early management of upper gastrointestinal (GI) hemorrhage are based on rapid diagnosis, risk stratification, and early management. Effective preendoscopic treatment may improve survivability of critically ill patients and improve resource allocation for all patients. Accurate risk stratification helps determine the need for hospital admission, hemodynamic monitoring, blood transfusion, and endoscopic hemostasis before esophagogastroduodenoscopy (EGD) via indirect measures such as laboratory studies, physiologic data, and comorbidities. Early management before the definitive EGD is essential to improving outcomes for patients with upper GI bleeding.
Collapse
|
7
|
Chung IK, Lee DH, Kim HU, Sung IK, Kim JH. [Guidelines of treatment for bleeding peptic ulcer disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 54:298-308. [PMID: 19934611 DOI: 10.4166/kjg.2009.54.5.298] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pylori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pylori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pylori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer.
Collapse
Affiliation(s)
- Il Kwun Chung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | | | | | | | | | | | | |
Collapse
|
8
|
Affiliation(s)
- Ian M Gralnek
- Department of Gastroenterology and Gastrointestinal Outcomes Unit, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| | | | | |
Collapse
|
9
|
Bjelović M, Sabljak P, Stojakov D, Vucelić D, Sokić-Milutinović A, Dunjić MS, Ebrahimi K, Velicković D, Spica B, Sljukić V, Pesko P. [Treatment of gastrointestinal hemorrhage manifestation induced by nonsteroidal anti-inflammatory agents]]. ACTA CHIRURGICA IUGOSLAVICA 2008; 55:17-21. [PMID: 19245135 DOI: 10.2298/aci0804017b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The risk of upper gastrointestinal tract bleeding in the patients taking NSAID estimates 1% per year. Bleeding stops spontaneously in approximately 80% of all cases. Persistent and repeated bleeding (expecialy during the initial hospitalization) still represent the serious clinical problem. In this group of patients, mortality rate is between 6-10%, which in the USA counts 10-20000 patients per year. AIM OF THE STUDY The purpose of this review is to update the current knowledge of the use of different therapeutic strategies in patients with NSAID induced upper gastrointestinal bleeding. RESULTS Proton pump inhibitors (PPI) therapy is effective as a prevention of NSAID induced acidopeptic lesions, and also represents the first and best therapeutic option for the treatment of complications, such as upper gastrointestinal bleeding. In the last three decades use of early flexibile (diagnostic and therapeutic) endoscopy, agressive acidosupression (PPIs), and surgical treatment in restrictive indications, resulted in decreasing of the mortality rates from 25-35% to 6-10%. When PPIs and flexible endoscopy are not sufficient in the control of upper gastrointestinal bleeding, use of systemic hemostatic drugs could be taken into consideration. CONCLUSION Multidisciplinary approach, precise diagnostic and therapeutic critearia would probably result in better outcome of patients with active upper gastrointestinal bleeding.
Collapse
Affiliation(s)
- M Bjelović
- Institut za bolesti digestivnog sistema, KCS Beograd
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Correale P, Sciandivasci A, Intrivici C, Pascucci A, Del Vecchio MT, Marsili S, Savelli V, Voltolini L, Di Bisceglie M, Guarnieri A, Gotti G, Francini G. Chemo-hormone therapy of non-well-differentiated endocrine tumours from different anatomic sites with cisplatinum, etoposide and slow release lanreotide formulation. Br J Cancer 2007; 96:1343-7. [PMID: 17437022 PMCID: PMC2360193 DOI: 10.1038/sj.bjc.6603734] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We report the results of a phase II trial in patients with metastatic endocrine tumours from different sites, which aimed to evaluate the anti-tumour activity and toxicity of a cisplatinum and etoposide regimen administered in combination with the somatostatin agonist lanreotide given in slow release formulation. Between January 1999 and November 2003, 27 patients with histological diagnoses of endocrine tumours with different degrees of differentiation, excluding well differentiated carcinoid neoplasms, received intravenous (i.v.) administration of cisplatinum (30 mg m−2) and etoposide (100 mg m−2) on days 1–3 and intramuscular administration of 60 mg lanreotide on day 1, in a 21-day cycle. All of the patients were evaluable for toxicity and response. The treatment was very well tolerated as no grade 4 toxicity was observed. Four patients achieved a complete response, six a partial response, 12 experienced disease stabilisation and five disease progression. The average time to progression and to survival were 9 and 24 months respectively. These results suggest that this chemo-hormone therapy regimen is well tolerated and active in patients with non-well differentiated endocrine tumours.
Collapse
Affiliation(s)
- P Correale
- Medical Oncology, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - A Sciandivasci
- Medical Oncology, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - C Intrivici
- Medical Oncology, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - A Pascucci
- Medical Oncology, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - M T Del Vecchio
- Medical Pathology Section, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - S Marsili
- Medical Oncology, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - V Savelli
- Second Division of General Surgery, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - L Voltolini
- Division of Thoracic Surgery, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - M Di Bisceglie
- Division of Thoracic Surgery, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - A Guarnieri
- Second Division of General Surgery, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - G Gotti
- Division of Thoracic Surgery, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
| | - G Francini
- Medical Oncology, Department of Human Pathology and Oncology, Siena University School of Medicine, Viale Bracci 11, 53100, Siena, Italy
- E-mail:
| |
Collapse
|