Page 1133 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 62 Drugs Used in the Treatment of Gastrointestinal Diseases 1119

Terdiman JP et al: American Gastroenterological Association Institute guide on the Hirschfield GM et al: Efficacy of obeticholic acid in patients with primary biliary
use of thiopurines, methotrexate, and anti-TNF-alpha biologic drugs for the cirrhosis and inadequate response to ursodeoxycholic acid. Gastroenterology
induction and maintenance of remission in inflammatory Crohn’s disease. 2015;148:751.
Gastroenterology 2013;145:1459.
Drugs for Portal Hypertension
Pancreatic Enzyme Supplements
Ahmed ME: Treatment of portal hypertension. World J Gastroenterol 2012;
Forsmark C: Management of chronic pancreatitis. Gastroenterology 2013; 18:1166.
144:1282. Garcia-Tsao G et al: Management of varices and variceal hemorrhage in cirrhosis.
Whitcomb DC et al: Pancrelipase delayed-release capsules (CREON) for exocrine N Engl J Med 2010;362:823.
pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery: A
double-blind randomized trial. Am J Gastroenterol 2010;105:2276. Drugs for Short Bowel Syndrome
Wier HA et al: Pancreatic enzyme supplementation. Curr Opin Pediatr 2011;23:541.
Buchman AL: Teduglutide and short bowel syndrome: Every night without
Bile Acids parenteral fluids is a good night. Gastroenterology 2012;143:1416.
Jeppesen PB et al: Teduglutide reduces need for parenteral support among
Hempfling W, Dilger K, Beuers U: Systematic review: Ursodeoxycholic acid— patients with short bowel syndrome with intestinal failure. Gastroenterology
Adverse effects and drug interactions. Aliment Pharmacol Ther 2003;18:963. 2012;143:1473.

C ASE STUD Y ANSWER

The immediate goals of therapy are to improve this young with an immunomodulator (eg, azathioprine or mercap-
woman’s symptoms of abdominal pain, diarrhea, weight topurine) in hopes of achieving long-term disease remis-
loss, and fatigue. Equally important goals are to reduce the sion. If satisfactory disease control is not achieved within
intestinal inflammation in hopes of preventing progression 3–6 months, therapy with an anti-TNF agent would then
to intestinal stenosis, fistulization, and need for surgery. One be recommended. Alternatively, patients with moderate-
option now is to step up her therapy by giving her a slow, to-severe Crohn’s disease who have failed mesalamine may
tapering course of systemic corticosteroids (eg, prednisone) be treated upfront with both an anti-TNF agent and immu-
for 8–12 weeks in order to quickly bring her symptoms and nomodulators, which achieves higher remission rates than
inflammation under control while also initiating therapy either agent alone and may improve long-term outcomes.