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Somatostatin Maintains High Intragastric pH in Patients With Peptic Ulcer Bleeding: Presented at UEGW

By Adrian Burton

MADRID, SPAIN -- November 6, 2003 -- Greek researchers have reported that somatostatin might be used effectively to control gastric acid secretion for the treatment of patients with peptic ulcer bleeding (PUB).

"There is some evidence suggesting that somatostatin is beneficial in the management of peptic ulcer bleeding," explained Dr. Alec Avgerinos, head of gastroenterology at the Evangelismos Hospital, Athens, Greece. "But there has been no evidence that it might affect gastric acid secretion. On the other hand, we do have some evidence that when you reduce gastric acid secretion that is beneficial for the outcome of these patients … [low pH] inhibits the formation of a clot at the site of a peptic ulcer. Our aim was to find out whether somatostatin affects gastric pH, so we had to compare it with a drug that is proven to reduce gastric acidity [pantoprazole], and with a placebo."

Dr. Avgerinos presented the study results here November 3^rd at the 11^th United European Gastroenterology Week.

Thirty-three PUB patients were randomly assigned to receive intravenous somatostatin (500 mcg/h/24 h + 250 mcg bolus), pantoprazole (8 mg/h/24 h + 80 mg bolus) or a saline placebo (n=11 in each group). The three groups were well-matched for age, sex, and PUB aetiology, etc.

The gastric pH of the patients was then monitored every 4 seconds in the fundus and body of the stomach (5 cm and 10 cm below the cardia) for 24 hours using a transnasally positioned crystal antimony pH catheter. At baseline, pH levels were similar in all groups. Somatostatin increased the pH of the fundus and body from 2.1±0.8 and 1.8±0.7 to 6±1.7 and 5.9±1.5. Similarly, the proven drug pantoprazole raised intragastric pH from 2.4±1 and 1.7±0.4 for the same areas, to 6.4±1.8 and 5.6±1.6. Both drugs significantly raised intragastric pH with respect to the placebo (p<0.0001 for both stomach sites and both drugs).

During the 24-hour recording period, the percentage of time the somatostatin patients' intragastric pH was above 4 was 79±27.7% and 79.4±26.1% in the fundus and body, respectively. In the pantoprazole patients, the percentages were 79.4±30.2% and 69.7±30.3%, respectively. In fact, in both groups, percentages of 60-70% were attained for time above the pH 6 threshold at both sites. There were no significant differences between the two treatment groups.

These results suggest the administration of somatostatin can be used as an acute treatment for PUB, explained Dr. Avgerinos. "We now need to translate this into a large clinical study and see what we get," he said.


[Study title: Efficacy of Somatostatin to Maintain High Intragastric pH in Patients With Peptic Ulcer Bleeding as Compared to Pantoprazole: A Prospective Randomized Placebo-Controlled Trial. Abstract Mon-G-189]

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