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Pancreatic Enzyme Replacement Therapy (PERT) and Gallstone Prevention – Gastrointestinal Drugs

by Pravin Shukle, MD
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    Let's move on to pancreatic replacement therapies. This is one of those other categories that are relevant to the GI system. Pancrelipase and pancreatin are given to patients who have inadequate secretion of endogenous pancreatic lipase. So the problem with not having enough pancreatic lipase is that you have these undigested or not broken down fragments of fat in the stool. And this causes severe diarrhea and malabsorption syndromes. Remember that vitamins A, D, E, and K are fat-soluble vitamins. If you don't have good pancreatic lipase activity, you're not going to absorb these vitamins. Now these products do come from pigs, so they are porcine drugs. So there can be some issues with some our Muslim patients who don't want to take these agents. They are a substitute for human pancreatic lipase. They are inactivated at pH levels below 4.0 which is why we give them as coated capsules so that we can get them pass the stomach and into the small bowel. Now, if you give these agents with antacids, it will actually improve the functionality of these agents. So unlike most drugs where we want the low pH, in this particular case, we weren't able to formulate it that way, and so we want a higher pH in the stomach. So giving it with antacids is quite reasonable. Let's move on to gallstone prevention. So, before we go on and talk about drugs, let me first say that the most effective way to prevent gallstones from occuring is drink lots of water. Having said that, let's move on to the medications cause that's what these lectures are about. Ursodiol is the most commonly used and probably the single agent at most countries used in the prevention of gallstones. Now, remember that cholesterol stones are caused by the...

    About the Lecture

    The lecture Pancreatic Enzyme Replacement Therapy (PERT) and Gallstone Prevention – Gastrointestinal Drugs by Pravin Shukle, MD is from the course Gastrointestinal Pharmacology.


    Included Quiz Questions

    1. A, D, E, K
    2. B, C, Biotin, Folate
    3. A, B, C, D
    4. All B vitamins are fat soluble
    5. Only B1 - B6 are fat soluble, the others are water soluble
    1. Increases fat content of bile.
    2. Decreases cholesterol content of bile.
    3. Breaking up micelles containing cholesterol.
    4. Decrease hepatic cholesterol secretion.
    5. Decrease cholesterol uptake by the intestine.

    Author of lecture Pancreatic Enzyme Replacement Therapy (PERT) and Gallstone Prevention – Gastrointestinal Drugs

     Pravin Shukle, MD

    Pravin Shukle, MD


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