Serum angiotensin I-converting enzyme levels and the therapeutic effects of octreotide in esophageal variceal hemorrhage.

INTRODUCTION

The aim of this study is to investigate the relationship between serum angiotensin I-converting enzyme (ACE) levels and therapeutic effects of octreotide in the treatment of esophageal variceal hemorrhage (EVH) as a result of liver cirrhosis.

METHODS

Serum ACE levels were measured by ultraviolet light colorimetric analysis in 80 cases of liver cirrhosis with EVH before and after the treatment of various doses of octreotide (25 and 50 μg/hr treatment in 40 cases, respectively), which were compared with 20 healthy controls.

RESULTS

Between the octreotide treatment groups, there were no significant differences in the Child-Pugh score, the endoscopic severity of esophageal varices and ACE levels before octreotide treatment. Pretreatment levels of serum ACE were markedly higher in patients with EVH compared with healthy controls (P < 0.001). Serum ACE levels were significantly higher before octreotide treatment than 72 hours after treatment in patients with EVH. Serum ACE after octreotide treatment declined more evidently in the 50 μg/hr than in the 25 μg/hr treatment group. The hemostatic rate within 6 hours after octreotide treatment was significantly higher in the 50 μg/hr than in the 25 μg/hr treatment group. The rebleeding rate within 72 hours after octreotide treatment was markedly lower in the 50 μg/hr than in the 25 μg/hr treatment group.

CONCLUSIONS

Octreotide treatment in patients with EVH can result in decreased serum ACE levels, which correlated with the dose of octreotide. The decline in serum ACE levels may be involved in the mechanisms by which octreotide lowers portal vein pressure in EVH treatment.