title: Pharmacological challenges in chronic pancreatitis.
abstract: Drug absorption in patients with chronic pancreatitis might be affected by the pathophysiology of the disease. The exocrine pancreatic insufficiency is associated with changes in gastrointestinal intraluminal pH, motility disorder, bacterial overgrowth and changed pancreatic gland secretion. Together these factors can result in malabsorption and may also affect the efficacy of pharmacological intervention. The lifestyle of chronic pancreatitis patients may also contribute to gastrointestinal changes. Many patients limit their food intake because of the pain caused by eating and in some cases food intake is more or less substituted with alcohol, tobacco and coffee. Alcohol and drug interaction are known to influence the pharmacokinetics by altering either drug absorption or by affecting liver metabolism. Since patients suffering from chronic pancreatitis experience severe pain, opioids are often prescribed as pain treatment. Opioids have intrinsic effects on gastrointestinal motility and hence can modify the absorption of other drugs taken at the same time. Furthermore, the increased fluid absorption caused by opioids will decrease water available for drug dissolution and may hereby affect absorption of the drug. As stated above many factors can influence drug absorption and metabolism in patients with chronic pancreatitis. The factors may not have clinical relevance, but may explain inter-individual variations in responses to a given drug, in patients with chronic pancreatitis.
authors.affiliation: Anne Estrup Olesen, Anne Brokjaer, Iben Wendelboe Fisher, Isabelle Myriam Larsen, Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark.
authors.forename: Anne Estrup
authors.initials: AE
authors.lastname: Olesen
authors.forename: Anne
authors.initials: A
authors.lastname: Brokjaer
authors.forename: Iben Wendelboe
authors.initials: IW
authors.lastname: Fisher
authors.forename: Isabelle Myriam
authors.initials: IM
authors.lastname: Larsen
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D018565:Food-Drug Interactions; D005769:Gastrointestinal Motility; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D007413:Intestinal Mucosa / Q000378:metabolism*; D007422:Intestines / Q000187:drug effects / Q000382:microbiology / Q000503:physiopathology; D008019:Life Style; D044342:Malnutrition / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D009752:Nutritional Status; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D010599:Pharmacokinetics; D019338:Polypharmacy
chemical_list: D000701:Analgesics, Opioid
keywords: Absorption; Chronic pancreatitis; Metabolism; Pharmacology; Treatment