G.G. Ginsberg, M.L. Kochman, I. Norton and C.J. Gostout, Clinical Gastrointesinal Endoscopy, Elsevier Ltd, London (2005) 874 pp., Price €219, ISBN 072-160-2827.
详细信息 查看全文
- 作者：G. Bianchi Porro
- 关键词：Acid inhibition ; Lanreotide ; Octreotide ; Peptic ulcer bleeding ; Somatostatin ; Vapreotide
- 刊名：Digestive and Liver Disease
- 出版年：2006
- 出版时间：February 2006
- 年：2006
- 卷：38
- 期：2
- 页码：153-154
- 全文大小：39 K
文摘
Peptic ulcer bleeding remains a common medical emergency and despite recent advances in management is still associated with high mortality. Endoscopic treatment remains the cornerstone for the effective management of high-risk patients. Recent evidence suggests that potent antisecretory drugs that inhibit gastric acid secretion, such as proton pump inhibitors, may be of help alone or in combination with endotherapy in the management of peptic ulcer bleeding. Somatostatin appears to offer a distinct advantage over antisecretory drugs, as it inhibits both acid and pepsin secretion and combines these effects with a reduction in gastroduodenal mucosal blood flow which seems to be important in the pathophysiology of peptic ulcer bleeding. Additionally, the inhibition of pepsin secretion might induce a decreased proteolytic activity preventing the dissolution of freshly formed clots at the site of bleeding. Despite its theoretical advantages, there has been very little evidence in the recent past in setting of randomised, controlled, clinical trials. In reviewing the available data, we found that the efficacy of somatostatin and its analogue octreotide are different in the control of peptic ulcer bleeding and this might be due to the different distribution of its receptors through the GI tract. Further studies are needed to define the exact role, if any, of somatostatin and its analogues, in high-risk patients with peptic ulcer bleeding and this might be a rather interesting area for future research.