ROLE OF OCTREOTIDE IN UPPER GASTROINTESTINAL BLEEDING DUE TO LIVER CIRRHOSIS

Background: Upper gastrointestinal bleeding is one of the important cause of mortality and morbidity globally. Two main causes of bleeding are variceal and non-variceal. In variceal bleeding the underlying cause is portal hypertension due to liver cirrhosis. Liver cirrhosis is chronic inflammatory process that causes liver necrosis, fibrosis and conversion of normal liver architecture into abnormal nodule formation. In western world, alcoholic liver disease is most common cause of liver cirrhosis but in our country the most common cause is viral hepatitis. Endoscopy is the gold standard treatment procedure for upper gastrointestinal bleeding. Octreotide play important role in variceal bleed. Objective: The aim of our study is to determine the efficacy of octreotide in upper gastrointestinal bleeding in patients waiting for endoscopy. Methodology: Study design is case series. 62 patients were enrolled through non probability sampling technique. Patients presented in emergency with upper gastrointestinal bleeding due to liver cirrhosis, after taking detailed history and going through their previous investigations and medical record were enrolled in the study. Results: Total 62 patients were enrolled in the study. 41 were male and 21 were female. Mean age was 48.4 +/- 7.9 SD. In comparison between Child-Pugh Class and age groups, in 20-35 years age group, 5 patients were from Child-Pugh Class A. 2 patients were in Child-Pugh Class B and 1 patient in Class C. In age group 36-50 years, 6 patients belong to Child-Pugh Class A, 9 patients were from Child-Pugh Class B and 10 patients were in Class C. In age group 51-65 years, 2 patients were in ChildPugh Class A, 9 were in Class B and 18 patients were in Child-Pugh Class C. In 35 patients out of total 62 bleeding was successfully controlled with continues infusion of octreotide in 24 hours. In 14 patients bleeding remained continue and in 13 patients there was episode of re-bleeding observed after 48 hours. In relation to Child-Pugh Class A, in 10 patients bleeding remained control, in 2 patients bleeding continued after 24 hours and 1 patient developed episode of re-bleeding. According to child-pugh class B, in 13 patients bleeding remained control, in 5 patients bleeding continued after 24 hours and 2 patients developed episode of re-bleeding. In child-pugh class C, 10 patients had re-bleeding. Out of 62 patients 4 patient died. Out of 4 patients, 3 belong to Child-Pugh Class C and 1 from Class B. Conclusion: Octreotide has shown good efficacy in patient of upper gastrointestinal bleeding due to liver cirrhosis, especially in Child-pugh class A. It is also a better option in patients waiting for endoscopy. Key words: Upper gastrointestinal bleeding, Octreotide, Liver cirrhosis, Variceal, Efficacy, Endoscopy.