Steatorrhea, effect

The answer is d. (Hardman, p 935.) Pancrelipase is an alcoholic extract of hog pancreas that contains lipase, trypsin, and amylase. It is effective in reducing the steatorrhea of pancreatic insufficiency None of the other drugs mentioned have significant action in the digestion of fats... 

Effects in Patients with Idiopathic Steatorrhea and Tropical Sprue. 89... 

The effect of reintroduction of gluten is readily demonstrated in patients who show complete recovery it is difficult to study, however, in those that do not return to normal. In the first group the reintroduction of wheat gluten or appropriate fractions has been shown to cause many effects including steatorrhea. The other effects of reintroduction of gluten will be discussed in detail later. 

As already mentioned, it is difficult to assess the effect of reintroduction of gluten into patients that are only partially recovered, since there are commonly large daily fluctuations in the fecal fat level. For the present it seems wise to retain the term idiopathic steatorrhea to cover these patients and to accept the view that they may exhibit varying degrees of gluten intolerance. 

R6. Rodriguez-Molina, R., Cancio, M., and Asenjo, C. F., The effect of folic acid on the steatorrhea of tropical sprue and other tests for intestinal absorption. Am. J. Trop. Med. Hyg. 9, 308-314 (1960). 

Many other dietary factors have been reported to affect calcium bioavailability. Phytate, fiber, cellulose, uronic acids, sodium alginate, oxalate, fat (only in the presence of steatorrhea), and alcohol have been reported to decrease calcium bioavailability (15). Lactose and medium chain triglyceride increase it (15). FTuoride also affects calcium retention primarily by stimulating bone formation thereby decreasing calcium excretion (33-38). The effects of fluoride on calcium utilization have been variable (34,38,39). 

Interest in the possible connection between intake of fat and absorption of calcium was generated by the concurrent massive losses of calcium in patients with steatorrhea, fatty diarrhea (46, 47). Ordinarily, however, fat is very efficiently absorbed from the gastrointestinal tract. Results of several studies in human adults and children indicate little or no effect of level of dietary fat on absorption of calcium (48-54). However, influence of level of dietary fat on calcium absorption in rat studies has produced conflicting results (55-57). 

Enhanced anticoagulant effects Endogenous factors that may be responsible for increased PT/INR response include the following Blood dyscrasias cancer collagen vascular disease CHF diarrhea elevated temperature hepatic disorders (eg, infectious hepatitis, jaundice) hyperthyroidism poor nutritional state steatorrhea vitamin K deficiency. 

Adverse effect of octreotide include nausea, vomiting, abdominal cramps and steatorrhea. 

Preparations high in lipase concentration seem to be more effective for reducing steatorrhea... 

The dose of enzyme required to treat steatorrhea may vary among individuals, and the dose should be individualized to achieve optimal therapeutic effects. In addition less-than-precise enzyme extraction and inconsistent enteric-coating procedures demand careful consideration in selecting from the array of pancreatic enzyme products now available. As much as a 30-fold difference may be seen in pancreatic enzyme activity among products after being exposed to simulated gastric fluid [19]. 

In patients who have preexisting bowel disease or cholestasis, steatorrhea may occur. Malabsorption of vitamin occurs rarely, leading to hypoprothrombinemia. Prothrombin time should be measured frequently in patients who are taking resins and anticoagulants. Malabsorption of folic acid has been reported rarely. Increased formation of gallstones, particularly in obese persons, was an anticipated adverse effect but has rarely occurred in practice. 

Adverse effects of octreotide therapy include nausea, vomiting, abdominal cramps, flatulence, and steatorrhea with bulky bowel movements. Biliary sludge and gallstones may occur after 6 months of use in 20-30% of patients. However, the yearly incidence of symptomatic gallstones is about 1%. Cardiac effects include sinus bradycardia (25%) and conduction disturbances (10%). Pain at the site of injection is common, especially with the long-acting octreotide suspension. Vitamin B12 deficiency may occur with long-term use of octreotide. 

Patients taking colestyramine often have constipation, abdominal discomfort, and heartburn, but dietary fiber, such as psyllium, can reduce the symptoms (5,6). Other effects are flatulence, nausea, and fecal impaction a mild laxative may be needed, particularly in the elderly. Many other patients complain of anorexia and occasionally there is diarrhea. Doses of colestyramine higher than the 10-16 g normally used can cause steatorrhea (7). 

Zurier RB, Hashim SA, Van Itallie TB. Effect of medium chain triglyceride on cholestyramine-induced steatorrhea in man. Gastroenterology 1965 49(5) 490-5. 

Adverse effects of therapy include nausea with or without vomiting, abdominal cramps, flatulence, and steatorrhea with bulky bowel movements. Biliary sludge and gallstones may occur after 6... 

Originally isolated from the hypothalamus, somatostatin is a small polypeptide that is also found in neurons throughout the body, as well as in the intestine and pancreas. Somatostatin therefore predictably has a number of actions. Octreotide [awk TREE oh tide] is a synthetic octapeptide analog of somatostatin. It has a much longer half-life than the natural compound and has found use in the treatment of acromegaly caused by hormone-secreting tumors, and secretory diarrhea associated with tumors producing the vasoactive intestinal peptide (VIP). Adverse effects of octreotide treatment are flatulence, nausea, and steatorrhea. 

Why are pancreatin microspheres with acid-resistant coating usually more effective in reducing steatorrhea than identical lipase doses provided as either plain pancreatin powder or monolithic capsules or tablets with acid-resistant coating ... 

Regrettably, the pharmacologist must confess that no drugs exist that can be recommended for the purpose of weight reduction. The so-called appetite suppressants (anorexiants) act only, if at all, for a limited period and are fraught with side effects. Most anorexiants are derivatives of metham-phetamine that have been withdrawn from the market. A different mechanism of action is involved in the case of an inhibitor of pancreatic lipase, which is required in the intestines for fat absorption. This inhibitor (orlistat) diminishes fat absorption so that fats reach the lower bowel, where they can cause disturbances flatulence, steatorrhea, and frequent need to relieve the bowels occur in about 30% of affected subjects. These symptoms correspond exactly to those seen in pancreatic hypofunction which are then usually treated with pancreatic lipase. Before an obese person submits to treatment with orlistat, he or she should voluntarily reduce the food fat content by one half to live free of such unpleasant adverse effects. 

Gastrotoxicity due to mefenamic acid is marked. Other than the common adverse effects (nausea, anorexia, vomiting, pain, diarrhea), acute peptic ulcer, intestinal hemorrhage, hematemesis, abdominal distension, and profuse steatorrhea (SEDA-2, 97) have been reported. Mefenamic acid, unhke other NSAIDs, can provoke enteritis and cohtis in patients with no known predisposing factors (8). It accelerates bowel transit in healthy volunteers (SEDA-16,112). 

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