The Influence of a Long-Acting Somatostatin Analogue on Splanchnic Haemodynamics and Metabolism in Healthy Subjects and Patients with Liver Cirrhosis

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Abstract
Wahren J, Eriksson LS. The influence of a long-acting somatostatin analogue on splanchnic haemodynamics and metabolism in healthy subjects and patients with liver cirrhosis. The influence of a long-acting somatostatin octapeptide analogue (SMS 201-995) on splanchnic circulation and metabolism has been studied in healthy subjects and in patients with liver cirrhosis. In healthy subjects doses of 5, 10, 50, or 100 μg SMS and in the cirrhotic patients 25 μg SMS were infused intravenously during 1 h. Measurements were obtained before, during, and for 1 h after SMS infusion. SMS infusion in healthy subjects resulted in a 25-35% reduction in hepatic blood flow. This effect was largely independent of the dose used. Splanchnic oxygen uptake was unchanged before and during SMS infusion. Insulin and glucagon levels fell markedly in response to SMS administration, and the blood concentration and splanchnic output of glucose decreased transiently. Patients with liver cirrhosis responded to SMS infusion similarly to the healthy subjects. Hepatic blood flow decreased by 25-35% and remained suppressed for at least 1 h after infusion. Wedge hepatic venous pressure was 18 ± 2 mm Hg in the basal state and decreased progressively during and after SMS infusion (60min after infusion, 15 ± 2 mm Hg; P<0.01). The marked hyperinsulinaemia and hyperglucagonaemia seen in the basal state decreased significantly during SMS administration. As in the case of the controls, blood concentration and splanchnic output of glucose fell transiently during and after SMS infusion. It is concluded that SMS exerts a marked and prolonged suppressive effect on hepatic blood flow in both healthy subjects and patients with liver cirrhosis. The portal venous pressure, as evaluated from the wedge hepatic venous pressure, tends to decrease in response to SMS in cirrhotic patients. The findings prompt clinical trials with regard to the possible usefulness of SMS as a therapeutic agent in the clinical management of patients with bleeding oesophageal varices and portal hypertension.