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
precipitation of cholesterol out of solution in the bile.
So, what ursodiol does is it reduces cholesterol content of
the bile by decreasing cholesterol uptake in the intestine.
It breaks up micelles that contain cholesterol
and it also decreases hepatic cholesterol secretion.
Now, toxicity with this agent is actually quite rare.
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.
So, patients who have obstetric cholestasis, we use ursodiol,
which tells you that it's a relatively non toxic agent.