Bile Acids and Pancreatic Enzymes
acids are constituents of bile and are synthesised from cholesterol. After
being secreted, they are largely reabsorbed in the ileum and recycled via an
enterohepatic cycle. Examples include cholic acid, deoxycholic acid,
chenodeoxycholic acid, ursodeoxycholic acid. They are used in the treatment of
gall-stones and primary biliary cirrhosis.
effects include diarrhoea, pruritis, dry skin, sweating, hair thinning, nausea,
dyspepsia, myalgia, rhinitis, insomnia.
Pancreatic enzymes are standardised
preparations of pancreas which contain protease, amylase, and lipase. They are
used in cases of pancreatic enzyme insufficiency, such as that found in cystic
fibrosis. Examples include pancreatin and pancreli-pase, which contain amylase,
lipase, and protease. They are used in the treatment of chronic pancreatitis
and pancreatic insufficiency. Adverse effects include nausea, diarrhoea, and
hyperuricaemia. Perianal irritation, particularly in infants, has been reported
with therapeutic use. Many of these prod-ucts are made from hog pancrease, and
hence, individuals sensitive to pork protein may experience allergic reactions.
Pancreatic alpha amylase and trypsin have been determined to be two of the
causative allergens. There have been several cases of these enzymes being
contaminated by Salmonella. Folate absorption is inhibited by use of pancreatic
extracts. These extracts form complexes with folates which reduce absorption.
Patients on chronic therapy should have folate monitored.
Toxicity is uncommon, but there have
been cases of hyper-sensitivity after inhalation, anal irritation, and oral
irritation when the tablets are held in the mouth. Asthma, bronchial
hypersensitivity, and pulmonary hypersensitivity have been reported after
exposure to the powder in both home and occu-pational settings. These symptoms
may occur in parents of children with cystic fibrosis. Fibrosing colonopathy
have been reported in children with cystic fibrosis following long-term
pancreatin therapy, with the majority of patients receiving high-dose
preparations. It has been theorised that delayed gastrointestinal transit time
and prolonged exposure of the colon to high-strength pancreatic enzymes in
cystic fibrosis patients may be associated with the development of fibrosing
colonopathy in these patients.
In general, pancreatic enzyme
tablets are low in toxicity and are not expected to produce serious overdose
effects. Treatment should be symptomatic and supportive. Patients should be
monitored for irritation of the gastrointestinal tract, possible
hypersensitivity reactions, and increased uric acid in the blood and urine.
Dilution may be indicated following inges-tion of large amounts in order to
reduce irritation. Immediately dilute with 4 to 8 ounces (120 to 240 ml) of
water or milk (not to exceed 4 ounces or 120 ml in a child). Activated charcoal
is generally not indicated because of low toxicity. Mild to moderate allergic
reactions may be treated with antihistamines with or without inhaled beta
agonists, corticosteroids or adrena-line. Treatment of severe anaphylaxis also
includes oxygen supplementation, aggressive airway management, adrenaline, ECG
monitoring and IV fluids.