Somatostatin is a 14 amino acid hormone. Octreotide is an
8 amino acid derivative of somatostatin with a much longer half-life.
Both have the same therapeutic properties.
Somatostatin and octreotide reduce portal blood flow and hepatic
venous pressure gradient but the effect on intra-esophageal pressure
is more equivocal in experimental studies.2
Both drugs are well tolerated. The major adverse effect is
hyperglycemia with rare reports of insulin requirement for management.3
The Cochrane Database Review with a meta-analysis of 820 adult patients
also found no difference in mortality with the use of somatostatin
or octreotide vs. placebo (OR 1.04, 95%CI 0.74-1.46). It reported
a positive effect with drug for number of transfusions per patient,
corresponding to 1.2U of blood product saved per patient (95%CI
0.8-1.6). This is likely not a clinically significant effect.2
The use of somatostatin or octreotide in the management of acute
non-variceal hemorrhage appears to significantly reduce the risk
of continued bleeding, but not alter the need for surgery nor decrease
the transfusion requirement significantly. The effectiveness
of the drug was limited to the subgroup with peptic ulcer bleeding.3
Gotzsche PC, Gjorup I, Bonnen H, Brahe NEB, Becker U, Burcharth
F. Somatostatin vs. placebo in bleeding esophageal varices:
Randomized trial and meta-analysis. BMJ. 1995; 310:1495-8.
Gotzch PC, Cochrane Database of Systematic Reviews: Somatostatin
or octreotide for acute bleeding esophageal varices. The
Cochrane Library 1999; Vol 2.
Siafakas C, Fox VL, Nurko S. Short communication: Use of octreotide
for the treatment of severe gastrointestinal bleeding in children.
J Pediatr Gastroenterol Nutr. 1998; 26:356-9.
Imperial TF, Birgisson S. Somatostatin or octreotide compared
with H2 antagonists and placebo in the management of acute non-variceal
upper gastrointestinal hemorrhage: A meta-analysis. Ann
Intern Med. 1997; 127:1062-71.