Vasoconstrictor therapy for upper GI bleeding

Vasoconstrictor therapy aims to restrict portal inflow by constricting the splanchnic arteries. It is employed before endoscopy and sclerotherapy, as an adjunct to the latter or if sclerotherapy has failed to control variceal bleeding.

Specific agents include:

• vasopressin
• terlipressin - a synthetic analogue of vasopressin
• octreotide - a somatostatin analogue, which has relatively few adverse effects
• somatostatin

NICE suggest that:

• terlipressin should be offered to patients with suspected variceal bleeding at presentation. Stop treatment after definitive haemostasis has been achieved, or after 5 days, unless there is another indication for its use

Reference:

• 1) NICE (August 2016). Acute Upper GI bleeding