Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UNIPROT:P01185 (vasopressin)
 23,126 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1) Emergency treatment. The best treatment remains endoscopic sclerotherapy, which controls the bleeding in 90% of the cases. Pharmacologic management stops the variceal hemorrhage in 80% of the cases and is indicated before endoscopic treatment can be performed. Intravenous somatostatin administration may be prolonged for 5 days, even more, and may thus prevent early rebleeding, which is not achieved neither by vasopressin nor by glypressin, which administration is restricted to 24 hours. Esophageal tamponade is useful to arrest a massive variceal bleeding, if vasoactive drugs are not available or not efficient, before endoscopic management. If the bleeding persists after 2 sclerotherapy sessions, an alternative treatment is mandatory: the patient should be sent to the surgeon for a portosystemic shunt if the operative risk is acceptable (child A and B) or should become a candidate for a transjugular intrahepatic stent shunt, especially if transplantation is considered afterwards. 2) Prevention of recurrent hemorrhage. A) Early (within 5 days after the initial bleeding). Somatostatin probably prevents early rebleeding, as do sclerotherapy. B) Late. B blockade (+ nitrates) or long-term sclerotherapy have the same efficacy. Their association may improve their results. 3) Prevention of the first bleeding episode. Propranolol decrease the risk of variceal rupture from 20% to 9% during the first year after the diagnosis of esophageal varices and is the only treatment which may be proposed to cirrhotics who did not yet bled form their varices.
 ...
PMID:[Prevention and treatment of digestive hemorrhage due to ruptured esophageal varices in patients with cirrhosis]. 136 Oct 90

The goals of therapy in acute variceal bleeding are to arrest haemorrhage and to prevent deterioration of liver function and complications related to bleeding. The measures used to stop acute bleeding should, ideally, also prevent the very early rebleeding that is frequently seen with bleeding varices. Variceal bleeding should be managed by a gastrointestinal bleeding team with intensive nursing care. Diagnostic endoscopy is mandatory once initial resuscitation has been achieved, and allows immediate injection sclerotherapy of varices. Drug therapy can be used as the first treatment in patients admitted with variceal bleeding since it can be given immediately. Of the available drugs, somatostatin has the least side effects and is as effective as vasopressin, terlipressin and the combination of vasopressin and an organic nitrate vasodilator. The role of drugs needs to be studied in combination with sclerotherapy. Sclerotherapy remains the mainstay of management as it achieves the twin goals of stopping active bleeding and preventing early rebleeding. Injection of tissue adhesive and endoscopic ligation or 'banding' are new endoscopic techniques that have shown promise in preliminary trials and are currently being assessed more widely. Balloon tamponade is a temporary measure used to prevent exsanguination. Surgery should be reserved for those patients in whom sclerotherapy is unsuccessful or cannot be carried out. Oesophageal staple transection is the most used operation. The new interventional radiological technique of transjugular intrahepatic portosystemic shunting will probably replace surgery in the future, but its role in acute variceal bleeding has yet to be fully defined.
 ...
PMID:Acute management of bleeding oesophageal varices. 138 67

In healthy adult goats, closure of the esophageal groove was induced by thirst, IV administered vasopressin, and intracarotid administration of hypertonic NaCl solutions. The efficiency of stimulation was tested directly by visual inspection of the course taken by orally administered solutions through a ruminal or abomasal fistula, palpation of the lips of the esophageal groove through a ruminal fistula, and indirectly by following the glucose dynamics in the blood after oral administration of glucose solution. Esophageal groove closure was observed during drinking after a 48-hour period of water deprivation. Intracarotid administration of 1.5 ml of a saturated solution or 10.5 ml of a 1.5% solution of NaCl also stimulated groove closure; however, groove closure stimulated by administration of vasopressin is the most satisfactory procedure for passing compounds of therapeutic importance directly from the cardiac orifice to the abomasum.
 ...
PMID:Stimulated esophageal groove closure in adult goats. 318 86

The effect of vasopressin on the lower esophageal sphincter pressure (LESP) is still poorly understood. The present study was designed to determine the effect of I.V. and intra-arterial administration of 8-arginine vasopressin (Pitressin) on the LESP in dogs. A total of 16 anesthetized mongrel dogs were given a continuous perfusion of Pitressin for 20 minutes. Group A (3 dogs): Infused at 2.75 mU/kg/min into the superior mesenteric artery. Group B (3 dogs): 2.75 mU/kg/min into a peripheral vein. Group C (5 dogs): 14 mU/kg/min into a peripheral vein (equivalent to therapeutic dose in humans). Group D (5 dogs): 28 mU/kg/min into a peripheral vein. Esophageal manometry was performed using a triple lumen polyvinyl tube assembly perfused with water at 0.4 ml/min. LESP was checked by the pull-through technique before, immediately and 30 minutes later after termination of the infusion. LESP was monitored at 3 locations during the infusion. No change in LESP was noted when Pitressin (2.75 mU/kg/min) was infused intra-arterial or I.V. I.V. infusion of 14 and 28 mU/kg/min Pitressin caused a significant sustained decrease in LESP (p less than 0.001). After infusion of 28 mU/kg/min, LESP failed to return to control levels in 30 minutes. The results suggest that intravenous administration of a high dose of Pitressin predisposes to gastroesophageal reflux during and shortly after infusion.
 ...
PMID:[Effect of Pitressin (8-arginine vasopressin) on the lower esophageal sphincter in dogs]. 647 51

The effect of vasopressin infusion on esophageal motor function was evaluated in 11 anesthetized dogs. Gastric fundic, lower esophageal sphincteric, and esophageal body pressures were measured during and after 1 hr infusion of vasopressin into the superior mesenteric artery or a systemic vein. Lower esophageal sphincteric pressures started to decrease significantly 10-15 min after the start of vasopressin infusion, reached the lowest level at 45-60 min, and returned to the control level or higher 1 hr after the end of infusion. No statistically significant difference was found between the effects of intravenous and intraarterial vasopressin infusions. Esophageal body and gastric fundic pressures remained unchanged. The result is inconsistent with the hypothesis that esophageal smooth muscle contractions reduce esophageal variceal hemorrhage during vasopressin infusions.
 ...
PMID:Canine esophageal motor function: effects of arterial and intravenous vasopressin. 678 35

Various treatment strategies have been used to control variceal bleeding, including drugs, esophageal tamponade, endoscopic sclerotherapy (ES), endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt and emergency surgery. None of these procedures are ideal and treatment frequently requires a combination of techniques. Sclerotherapy is one of the most widely used methods to control variceal bleeding; however, success is largely dependent on an experienced endoscopist. Vasoactive drugs act by decreasing pressure and blood flow in the gastroesophageal collaterals and they offer the advantage of being administered by inexperienced personnel. Drugs currently used in the treatment of variceal hemorrhage include vasopressin, terlipressin, somatostatin and octreotide. In the clinical studies to date, somatostatin was more effective than vasopressin and as effective as terlipressin in the control of bleeding esophageal varices (BEV), with an improved safety profile. In contrast, octreotide has shown conflicting results and more data are required to support the drug in this indication. More recently the ABOVE (Acute Bleeding Esophageal Variceal Episodes) study has provided further evidence that early administration of vasoactive drugs such as somatostatin is significantly more effective than placebo in the overall control of acute BEV episodes in cirrhotic patients undergoing ES. Therefore, the administration of a vasoactive drug as early as possible before emergency sclerotherapy is recommended for the effective management of BEV.
 ...
PMID:Approach to the management of bleeding esophageal varices: role of somatostatin. 960 41

Esophageal and gastric variceal bleeding is one of the most severe complications of portal hypertension and with high mortality. The aim of the therapy is to stop bleeding, replace the lost amount of blood and erythrocytes, treat coagulopathy, prevent rebleeding and improve liver function. Commonly accepted method to stop bleeding from varices is endoscopic hemostasis. Four vasoactive drugs, two natural peptides (vasopressin and somatostatin) and their analogues (terlipressin and octreotide) can control acute bleeding from gastric and esophageal varices. They lower portal pressure and the pressure in colateral circulation by vasoconstriction in splanchnic basin, and by inhibition the activity of endogenous vasodilatators. The high incidence of serious side-effects of vasopressin, even with nitroglycerin, has limited its application and decreased the use of this drug, with its abandonment in Europe. The vasopressin analogue, terlipressin, has a lower number of side-effects and is more effective in control of bleeding. Early terlipressin application at home, prior to hospital admission, diminishes mortality due to bleeding, thus attaching additional importance to this drug. Somatostatin, when applied as intravenous bolus injection, controls acute bleeding very efficiently and quickly. Five day somatostatin infusion after endoscopic hemostasis prevents rebleeding, with minimal side-effects. Octreotide is very efficient in long-term therapy of endocrine tumors due to its longer half-life, better hormone inhibition, and simple application compared to somatostatin. Like somatostatin, it can also control variceal bleeding. It appears that the long-term subcutaneous octreotide application prevents rebleeding and improves liver function, all of which yields a new dimension to its use.
 ...
PMID:[Drug therapy of hemorrhage in esophageal and gastric varices: role of vasoactive drugs]. 1129 Dec 71