Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In conclusion, Neoral gives more consistent drug absorption, achieving better pharmacokinetic predictability. Among other advantages, this results in a close correlation between trough blood levels and drug exposure (AUC) so that trough blood levels can be used as a more meaningful monitoring parameter when using the new formulation. Studies have also now confirmed that absorption of Neoral is bile independent, making it more useful in the early postoperative period and in the setting of cholestasis and rejection. Furthermore, studies have now demonstrated that in patients who have problems absorbing Sandimmune such as patients with cystic fibrosis, pancreatitis, or Crohn's disease, conversion to Neoral results in correction of malabsorption of CyA. Issues that need to be addressed in the future will include long-term toxicity associated with maintaining high Cmax and AUC; whether the introduction of Neoral can result in steroid sparing; and whether the introduction of Neoral will result in a reduced incidence of acute and chronic rejection.
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PMID:Neoral in liver transplantation. 862 16

In conclusion, Neoral gives more consistent drug absorption, achieving better pharmacokinetic predictability. Among other advantages, this results in a close correlation between trough blood levels and drug exposure (AUC) so that trough blood levels can be used as a more meaningful monitoring parameter when using the new formulation. Studies have also now confirmed that absorption of Neoral is bile independent, making it more useful in the early postoperative period and in the setting of cholestasis and rejection. Furthermore, studies have now demonstrated that in patients who have problems absorbing Sandimmune such as patients with cystic fibrosis, pancreatitis or Crohn's disease, conversion to Neoral results in correction of malabsorption of CyA. More recent data suggests that induction with Neoral results in a marked reduction in the incidence of acute rejection and allows for withdrawal of steroids and normalization of blood glucose, serum triglyceride, and cholesterol even when withdrawal is done 1 year after transplantation. Despite the high Cmax and AUC, there appears to be no increased toxicity in patients treated with Neoral. Issues that need to be addressed in the future include long-term toxicity associated with maintaining high Cmax and AUC and confirmation that the use of Neoral results in a reduction of both acute and chronic rejection.
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PMID:Neoral therapy in liver transplantation. 876 6

Inflammatory bowel disease, in addition to intestinal involvement, may be complicated also by other extra-intestinal manifestations. Moreover, drugs commonly employed in the treatment of ulcerative colitis and Crohn's disease may induce iatrogenic pancreatitis. Acute pancreatitis is described in two ulcerative colitis patients following azathioprine treatment.
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PMID:Acute pancreatitis after azathioprine treatment for ulcerative colitis. 878 4

We describe the case of a 27 year-old man with Crohn's Disease of the duodenum associated with pancreatitis and cholestatic syndrome secondary to sclerosing cholangitis. Pancreatitis resolved along with the clinical improvement of Crohn's Disease. This case supports the concept of an association between duodenal Crohn's Disease, sclerosing cholangitis and pancreatitis.
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PMID:[Crohn's disease of the duodenum complicated by sclerosing cholangitis and pancreatitis]. 892 29

A 38-year-old male patient who had been treated for Crohn's disease was found to have serum lipase activity that was persistently increased approximately 10-fold above the normal upper limit. He was diagnosed with chronic pancreatitis based on slightly elevated elastase-1 level and retrograde pancreatography showing slight dilatation of the main pancreatic duct. Therefore, the hyperlipasemia was thought to be due to pancreatitis. However, the serum amylase and trypsin was not increased at any time, and no serious findings suggestive of pancreatitis were detected on morphologic examination. Thus, there were discrepancies between the serum lipase activity and other laboratory and clinical findings. Exclusion chromatography of the patient's serum suggested macromolecular lipase, and further immunologic testing including affinity chromatography, enzyme-linked immunosorbent assay, and immunoprecipitation assay showed that serum lipase was bound to immunoglobulin Gkappa. Therefore, the hyperlipasemia was caused by immunoglobulin-linked lipase, termed "macrolipasemia." Macrolipasemia has rarely been reported, and this is the first reported case of macrolipasemia accompanied by Crohn's disease.
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PMID:Macrolipasemia in Crohn's disease. 951 Jan 45

Stapled ileal pouch-anal anastomosis after proctocolectomy enables a continence preserving reconstruction. We assessed complications and functional outcome after ileoanal pouch-anastomosis in 86 consecutive patients with ulcerative colitis. There was no postoperative mortality. 2 patients required permanent ileostomy and pouch excision for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis (n = 2), anastomotic leakage (n = 4), bleeding (n = 1), pancreatitis (n = 3) and peritonitis (n = 1). Both frequencies of bowel movements and degree of continence improved with time. Two years after take down of the deviation ileostomy frequency of bowel movements was 5,6 [2]/die. At this time no patient complained of major incontinence. Minor incontinence was reported with 9% and 14% during day-time and night-time respectively. It is concluded that direct stapled ileal pouch-anal anastomosis is a safe procedure with excellent functional results for patients with ulcerative colitis.
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PMID:[Direct ileum pouch-anal anastomosis in ulcerative colitis: function and complications after stapler technique]. 962 98

Azathioprine and its metabolite 6-mercaptopurine are effective in the treatment of inflammatory bowel disease. They are mostly used for reduction of the use of steroids, maintenance therapy after remission induction by cyclosporin and treatment of fistulae in Crohn's disease. Adverse effects occur in about 15% of patients. The main side effects are pancreatitis, allergic reactions, fever and bone marrow suppression. Symptoms, management and prevention are discussed. A blood monitoring schedule is suggested. Azathioprine and 6-mercaptopurine seem to be safe in pregnancy. There may be a slight increased risk for developing a non-Hodgkin's lymphoma.
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PMID:Azathioprine in inflammatory bowel disease, a safe alternative? 970 98

Pathological processes and diseases of the upper gastrointestinal tract have become increasingly recognized over recent years as childhood entities responsible for a variety of upper gastrointestinal symptoms previously labelled as functional or non-organic. The term 'dyspepsia' is an adult one whose definition requires clarification before use in the paediatric context, but it encompasses age-dependent symptoms such as feed-associated irritability in the infant, peri-umbilical pain in the younger child, and heart-burn, nausea, and indigestion in the older child as in adults. The possible organic conditions giving rise to such symptoms are multiple and multiorgan and include: gastro-oesophageal reflux; peptic ulcer disease; upper gastrointestinal Crohn's disease; antroduodenal motility disorders; pancreatitis; cholecystitis; cholelithiasis; biliary dyskinesia; and abdominal migraine. However, Munchausen syndrome by proxy must not be forgotten. Non-ulcer dyspepsia, it is now clear, has a basis in altered gastroduodenal motility and may be amenable to propulsion agents. In many individuals the dyspeptic symptoms of recurrent abdominal pain may be altered by psychotherapeutic intervention. Indeed there remains a proportion of children who undoubtedly have a behavioural or psychological base to their complaint. Nevertheless, with the recent increase in diagnostic yield from improved technical investigative aids available to paediatrics in the last 5-10 years, it is clear that the responsibility of the paediatrician to the child to find a cause of their symptoms is paramount. The variety of presenting features, possible causes of these symptoms, and appropriate investigation and treatment will be discussed, and management algorithms based on published literature and personal practice will be offered.
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PMID:Dyspepsia in infants and children. 989 91

We report a 74-yr-old woman with Crohn's disease and acute pancreatitis who, 3 yr after resolution of the latter, developed cystadenocarcinoma of the pancreas. No drug, toxin, or other etiologies including contiguous duodenal involvement were identified as responsible for the pancreatitis, suggesting that pancreatitis was an extraintestinal manifestation of her Crohn's disease. Could Crohn's-associated pancreatitis be a premalignant state for cystadenocarcinoma of the pancreas?
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PMID:Pancreatitis associated with Crohn's disease: a premalignant state for cystadenocarcinoma of pancreas? 1044 70

Numerous adult studies show a 30-65% response rate to azathioprine (AZA) or 6-mercaptopurine (6-MP) for significant perianal Crohn's disease. The aim of this study was to evaluate whether these drugs healed pediatric perianal Crohn's disease. Records of pediatric Crohn's patients were retrospectively reviewed for significant perianal disease treated with AZA or 6-MP for > or =6 months. The patient's perianal disease was reviewed and evaluated for fistulas, drainage, induration, and tenderness. In addition, the patients were given a score using the Irvine Perianal Disease Activity Index (PDAI). Patients were retrospectively scored upon initiation of treatment and after six months of therapy. Possible scores ranged from 0-20. Twenty patients met the study criteria. Five patients were considered treatment failures. One patient required a colostomy after 1.5 months of therapy, one developed pancreatitis, and three were noncompliant with therapy. Of the remaining 15 patients who were treated for > or =6 months, 67% had an improvement in drainage, 73% in tenderness, 60% in induration, and 40% in fistula closure. The mean Irvine PDAI was 7.67 +/- 2.19 initially and 4.40 +/- 1.72 after six months of therapy. The improvement was statistically significant (p < 0.001). AZA and 6-MP are effective treatments for healing significant perianal Crohn's disease in pediatrics.
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PMID:Azathioprine and 6-mercaptopurine for the treatment of perianal Crohn's disease in children. 1077 91


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