Page 28 - Delaware Medical Journal - March 2017
P. 28
a pressure elevation in the bile ducts.14 The above discussion elucidates the effects of opioids (μ-agonist) on biliary physiology, and its association as a causal agent
for acute pancreatitis. Still, opioids are commonly used in the management of pain in acute pancreatitis. Current guidelines
do not prefer one narcotic over another, for pain management in acute pancreatitis patients who had cholecystectomy.15 Thus, further studies should be considered in the eluxadoline on the pancreatobiliary system.
Finally, this drug is relatively new and physicians should become familiar with its adverse effects. Acute pancreatitis is one of the serious complications associated
REFERENCES
1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta analysis. Clin Gastroenterol Hepatol. 2012;10:712-721.
2. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterol. 2009;136:741-754.
3. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical r.eview. JAMA. 2015;313:949-958.
4. Garnock-Jones KP. Eluxadoline: first global approval. Drugs. 2015;75:1305-1310.
5. Kurz A, Sessler DI. Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs. 2003;63:649-671.
6. Fujita W, Gomes I, Dove LS, Prohaska
D, McIntyre G, Devi LA. Molecular characterization of eluxadoline as a potential ligand targeting mu-delta opioid receptor heteromers. Biochem Pharmacol. 2014;92:448-456
with eluxadoline, and it is evident that prior cholecystectomy increases this risk. IBS patients are more prone to undergo surgeries, including cholecystectomy, often due to misdiagnosis.16 And because of the prevalence of IBS, the number of IBS-D patients with prior cholecystectomy treated with eluxadoline is likely to increase. This may lead to an increase in the number of cases of acute pancreatitis associated with eluxadoline. It is important that future studies are designed to better understand this association, so as to help formulate treatment recommendations for IBS-D patients. In the meantime, physicians in an individualized fashion with patients and educate them prior to initiating eluxadoline therapy.
7. Davenport JM, Covington P, Bonifacio
L, McIntyre G, Venitz J. Effect of uptake transporters OAT3 and OATP1B1 and efflux transporter MRP2 on the pharmacokinetics of eluxadoline. J Clin pharmacol. 2015;55:534- 542.
8. Lembo AJ, Lacy BE, Zuckerman MJ,et al. Eluxadoline for irritable bowel syndrome with diarrhea. N Engl J Med. 2016;374:242-253.
9. Dove LS, Lembo A, Randall CW, et al. Eluxadoline benefits patients with irritable bowel syndrome with diarrhea in a phase 2 study. Gastroenterol. 2013;145:329-338.
10. Trivedi CD, Pitchumoni CS. Drug-induced pancreatitis: an update. J Clin Gastroenterol. 2005;39:709-716.
11. Hastier P, Buckley MJ, Peten EP, et al. A new source of drug-induced acute pancreatitis: codeine. AJG. 2000;95:3295-3298.
12. Thompson DR. Narcotic analgesic effects on the sphincter of oddi: a review of the data and therapeutic implications in treating pancreatitis. AJG. 2001;96:1266-1272.
CONTRIBUTING AUTHORS
■ ANUJ CHHAPARIA, MD is a Resident in the Department of Internal Medicine at Saint Louis University School of Medicine in St. Louis, Mo.
■ MUHAMMAD B. HAMMAMI, MD is a Fellow in the Division of Gastroenterology and Hepatology at Saint Louis University School of Medicine, Mo.
■ ASHLEY VAREEDAYAH, MD is a Fellow in the Division of Gastroenterology and Hepatology at Saint Louis University School of Medicine, Mo.
■ KATIE SCHROEDER, MD is an Assistant Professor in the Department of Internal Medicine, Division of Gastroenterology and Hepatology at Saint Louis University School of Medicine, Mo.
13. Coelho JC, Runkel N, Herfarth C, Senninger N, Messmer K. Effect of analgesic drugs on the electromyographic activity of the gastrointestinal tract and sphincter of
oddi and on biliary pressure. Ann Surg. 1986;204:53-58.
14. Tanaka M, Ikeda S, Nakayama F. Change in bile duct pressure responses after cholecystectomy: loss of gallbladder
as a pressure reservoir. Gastroenterol. 1984;87:1154-1159.
15. Banks PA, Freeman ML. The Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. AJG. 2006;101:2379-2400.
16. Sobolewska-Wlodarczyk A, Wlodarczyk
M, Storr M, Fichna J. Clinical potential of eluxadoline in the treatment of diarrhea- predominant irritable bowel syndrome. Ther Clin Risk Manage. 2016;12:771-775.
92
Del Med J
| March 2017
| Vol. 89 |
No. 3
