The use of somatostatin and octreotide in the treatment of gastrointestinal bleeding

Acute upper gastrointestinal bleeding is the most common gastroenterological emergency and has a considerable morbidity and mortality. Acute upper gastrointestinal bleeding can be divided into variceal and non-variceal bleeding. This is because these two pathologies differ in patient characteristics, endoscopic and medical management, rebleeding rates and prognosis. Acute variceal bleeding is a major complication of portal hypertension and represents the leading cause of death in patients with cirrhosis. It is currently recommended to combine pharmacological and endoscopic therapies for the initial treatment of the acute bleeding. Vasoactive drugs (preferably somatostatin or terlipressin) should be given as soon as variceal bleeding is suspected (ideally during the transfer to hospital) and maintained afterwards for 2-5 days to prevent early rebleeding. The choice of drug largely depends on local availability and clinician's experience in its use. Somatostatin and its analogue octreotide have been used for three decades in treatment of acute variceal bleeding. These drugs have been shown to decrease portal venous pressure and collateral blood flow. Major side effects of somatostatin and octreotide are extremely rare. These vasoactive drugs are effective, safe and their administration does not require any special procedure or expertise. That is the reason why these agents should be used as the first-line of treatment acute esophageal variceal bleeding.