Somatostatin in the Treatment of Hematemesis and Melena
Clinical trials generally show a trend towards reduced rebleeding rates in patients with hematemesis and melena due mainly to nonvariceal causes. Evidence of benefit to patients by reduced mortality is lacking. This may in part be due to the failure of investigators to accept that very large trials are needed if confident answers are to be obtained. Hardly any trials of any treatment are of adequate size.
In the United Kingdom about 1 in 2000 of the population is likely to suffer from upper gastrointestinal bleeding in an average year, or about 30,000 cases in all, and up to 10% will be likely to die. Improving treatment is therefore a worthwhile exercise. The possibilities include drug and electrophysical methods, but these are not mutually exclusive. Drug treatments also have the attraction that they are not dependent on clinical expertise for administration.
Available evidence suggests that useful improvements in outcome may be obtainable using histamine H2 antagonists (1), and with tranexamic acid (2) although the evidence is not certain. As somatostatin has powerful actions in inhibiting gastric acid secretion and reducing blood flow, it has, logically, been examined as a treatment for upper gastrointestinal bleeding.
KeywordsConfidence Limit Gastric Acid Secretion Tranexamic Acid Severe Bleeding Reduce Blood Flow
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- 7.Torres AJ, Landa I, Hernandes F, et al. Somatostatin (SS) in the treatment of upper gastrointestinal (GI) bleeding. A multicentre controlled trial [Abstract]. International Conference on Somatostatin, Washington, DC, May 6–8, 1986.Google Scholar