Secretin and somatostatin in the treatment of upper gastrointestinal haemorrhage.

Secretin inhibits gastric secretion of acid and gastrin in dog and a physiological role of secretin as an enterogastrone has been suggested in this species. In man there are diverging results concerning the effect of secretin on gastric secretion. Secretin has been used in patients with upper gastrointestinal bleeding and positive results have been reported, but the patients included in these studies cannot be considered as massive bleeders. Until now no double-blind study comparing secretin with placebo has been reported. Somatostatin decreases splanchnic blood flow and gastric secretion in man. Somatostatin seems to be effective in achieving initial haemostasis in patients with bleeding oesophageal varices. The peptide has also been shown to stop severe and persistent peptic ulcer haemorrhage and to stop bleeding in patients treated with steroidal and non-steroidal anti-inflammatory drugs. In one double-blind trial in patients with upper gastrointestinal bleeding, somatostatin had no effect on either the number of emergency operations or the number of rebleedings. In another double blind study, when somatostatin was compared with placebo in patients with massive upper gastrointestinal bleeding, the peptide reduced the number of emergency operations. In conclusion, most studies show positive effects of somatostatin on variceal and peptic ulcer haemorrhage.