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

00:01 Let's move on to pancreatic replacement therapies.

00:04 This is one of those other categories that are relevant to the GI system.

00:10 Pancrelipase and pancreatin are given to patients who have inadequate secretion of endogenous pancreatic lipase.

00:18 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.

00:28 And this causes severe diarrhea and malabsorption syndromes.

00:32 Remember that vitamins A, D, E, and K are fat-soluble vitamins.

00:37 If you don't have good pancreatic lipase activity, you're not going to absorb these vitamins.

00:43 Now these products do come from pigs, so they are porcine drugs.

00:49 So there can be some issues with some our Muslim patients who don't want to take these agents.

00:54 They are a substitute for human pancreatic lipase.

00:58 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.

01:08 Now, if you give these agents with antacids, it will actually improve the functionality of these agents.

01:15 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.

01:25 So giving it with antacids is quite reasonable.

01:28 Let's move on to gallstone prevention.

01:31 Ursodiol is the most commonly used and probably the single agent at most countries used in the prevention of gallstones.

01:40 Now, remember that cholesterol stones are caused by the precipitation of cholesterol out of solution in the bile.

01:47 So, what ursodiol does is it reduces cholesterol content of the bile by decreasing cholesterol uptake in the intestine.

01:56 It breaks up micelles that contain cholesterol and it also decreases hepatic cholesterol secretion.

02:05 Now, toxicity with this agent is actually quite rare.

02:09 And we also have used this medication in pregnant patients who are complaining of severe pruritus or itching which is often caused by obstetric cholestasis.

02:19 So, patients who have obstetric cholestasis, we use ursodiol, which tells you that it's a relatively non-toxic agent.