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The Impact of Intestinal Failure on Oral Drug Absorption: A Review

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Intestinal failure is a complex gastroenterological condition that occurs as a result of reduced intestinal absorption of nutrients and/or water and electrolytes. Without treatment, nutritional depletion and/or dehydration will result. It can be acute or chronic and occurs secondary to a variety of causes, including massive bowel resection, inflammatory bowel diseases of the bowel, and small bowel dysfunction.

Results and Discussion

Resection of the small bowel results in a range of physiological changes that affect the absorption of nutrients, water, and electrolytes. In addition, these changes may also affect the absorption of orally administered medication. However, there is only minimal published literature regarding this, with the publications limited to case reports of failure or efficacy of certain medicines such as digoxin and warfarin in individual patients. Due to the highly heterogeneous nature of intestinal failure patients, there is little generalizability of the information within these articles to other patients. Only one article seeks to provide limited practical advice regarding prescribing in this complex patient group.

Conclusion

The input of specialist pharmacists is necessary in the management of these patients to ensure that appropriate drugs and formulations are prescribed in a timely manner to optimize absorption and resultant efficacy.

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References

  1. O’Keefe SJD, Buchman AL, Fishbein TM, Jeejeebhoy KN, Jeppesen PB, Shaffer J. Short bowel syndrome and intestinal failure: consensus definitions and overview. Clinical Gastroenterology and Hepatology 2006;4:6–10.

    Article  PubMed  Google Scholar 

  2. American Gastroenterological Association. Medical position statement: Short bowel syndrome and intestinal transplantation. Gastroenterology 2003;124:1105–1110.

    Article  Google Scholar 

  3. McFadden MA, DeLegge MH, Kirby DF. Medication delivery in the short-bowel syndrome. Journal of Parenteral and Enteral Nutrition 1993;17:180–186.

    Article  CAS  PubMed  Google Scholar 

  4. Parsons RL. Drug absorption in gastrointestinal disease with particular reference to malabsorption syndromes. Clinical Pharmacokinetics 1977; 2: 45–60.

    Article  CAS  PubMed  Google Scholar 

  5. Dickerson RN, Melnik G. Osmolality of oral drug solutions and suspensions. American Journal of Hospital Pharmacy 1988; 45: 832–834.

    CAS  PubMed  Google Scholar 

  6. Lutomski DM, Gora ML, Wright SM, Damaldy IC, Chayer S. Sorbitol content of selected oral liquids. Annals of Pharmacotherapy 1993; 27: 269–274.

    CAS  PubMed  Google Scholar 

  7. Hill DB, Henderson LM, McClain CJ. Osmotic diarrhoea induced by sugar-free theophylline solution in critically ill patients. Journal of Parenteral and Enteral Nutrition 1991; 15: 332–336.

    Article  CAS  PubMed  Google Scholar 

  8. Bongaerts GP, Tolboom JJ, Naber AH, Speri WJ, Serverijnen RS, Bakkeren JA. Role of bacteria in the pathogenesis of short bowel syndrome-associated D-lactic acidemia. Microbial Pathogenesis 1997;22:285–293.

    Article  CAS  PubMed  Google Scholar 

  9. Thomson FC, Naysmith MR, Lindsay A. Managing drug therapy in patients receiving enteral and parenteral nutrition. Hospital Pharmacist 2000; 7: 155–164.

    Google Scholar 

  10. Gubbins PO, Bertch KE. Drug absorption in gastrointestinal disease and surgery. Clinical pharmacokinetic and therapeutic implications. Clinical Pharmacokinetics 1991;21:431–447.

    Article  CAS  PubMed  Google Scholar 

  11. Russo Jr J, Watson WA, Nelson EW. Cimetidine bioavailability after massive small bowel resection. Clinical Pharmacy 1982;1:558–561.

    PubMed  Google Scholar 

  12. Mitchell JF, Maas LC, Barger RC, Gelzayd EA. Successful oral anticoagulation therapy in a patient with short bowel syndrome. American Journal of Hospital Pharmacy 1977;24:171–172.

    Google Scholar 

  13. Lutomski DM, LaFrance RJ, Bower RH, Fischer JE. Warfarin absorption after massive small bowel resection. American Journal of Gastroenterology 1985;80:99–102.

    CAS  PubMed  Google Scholar 

  14. Lehman ME, Kolb KW, Barnhart GR, Wagman LD, Barr WH. Warfarin absorption in a patient with short-bowel syndrome. Clinical Pharmacy 1985;4:325–326.

    CAS  PubMed  Google Scholar 

  15. Kearns RJ, O’Reilly RA. Bioavailability of warfarin in a patient with severe short bowel syndrome. Journal of Parenteral and Enteral Nutrition 1986;10:100–101.

    Article  PubMed  Google Scholar 

  16. Owens JP, Mirtallo JM, Murphy CC. Oral anticoagulation in patients with short-bowel syndrome. Annals of Pharmacotherapy 1990;24:585–589.

    CAS  PubMed  Google Scholar 

  17. Lutomski DM, Palascak JE, Bower RH. Warfarin resistance associated with intravenous lipid administration. Journal of Parenteral and Enteral Nutrition 1987;11:316–318.

    Article  CAS  PubMed  Google Scholar 

  18. Baxter and Stockley. Stockley’s Drug Interactions. London: Pharmaceutical Press, 2007.

    Google Scholar 

  19. Brophy DF, Ford SL, Crouch MA. Warfarin resistance in a patient with short bowel syndrome. Pharmacotherapy 1998;18:646–649.

    CAS  PubMed  Google Scholar 

  20. Vetticaden SJ, Lehman ME, Barnhart GR, Barr WH. Digoxin absorption in a patient with short-bowel syndrome. Clinical Pharmacy 1986;5:62–64.

    CAS  PubMed  Google Scholar 

  21. Krauz MM, Berry E, Freund U, Levy M. Absorption of orally administered digoxin after massive resection of the small bowel. American Journal of Gastroenterology 1979;71:220–223.

    Google Scholar 

  22. Heizer WD, Pittman AW, Hammond JE, Fitch DD, Bustrack JA, Hull JH. Absorption of digoxin from tablets and capsules in subjects with malabsorption syndromes. DICP Annals of Pharmacotherapy 1989;23:764–769.

    CAS  Google Scholar 

  23. Kennedy JM, Van Riji AM. Effects of surgery on the pharmacokinetic parameters of drugs. Clinical Pharmacokinetics 1998;35:293–312.

    Article  CAS  PubMed  Google Scholar 

  24. Ehrenpreis ED, Guerriero S, Nogueras JJ, Carroll MA. Malabsorption of digoxin tablets, gel caps, and elixir in a patient with an end jejunostomy. Annals of Pharmacotherapy 1994;28:1239–1240.

    CAS  PubMed  Google Scholar 

  25. Silomon M, Bach F, Juckenhöfel S, Claus T, Molte G. Bioverfügbarkeit von Sotalol bei verkürzter gastrointestinaler passage. [Bioavailability of sotalol in short bowel syndrome: English abstract]. Medizinische Klinik 1999;94:638–641.

    Article  CAS  PubMed  Google Scholar 

  26. Evard D, Aubry JP, Le Quintrec Y, Cheymol G, Cheymol A. Study of the bioavailability of pindolol in malabsorption syndromes. British Journal of Clinical Pharmacology 1984;18:632–637.

    CAS  PubMed  Google Scholar 

  27. Robbins B, Reiss RA. Amitriptyline absorption in a patient with short bowel syndrome. American Journal of Gastroenterology 1999;94:2302–2304.

    Article  CAS  PubMed  Google Scholar 

  28. Broyles JE, Brown RO, Self TH, Frederick RC, Luther RW. Nortriptyline absorption in short bowel syndrome. Journal of Parenteral and Enteral Nutrition 1990;14:326–327.

    Article  CAS  PubMed  Google Scholar 

  29. Ueno T, Tanaka A, Hamanaka Y, Suzuki T. Serum drug concentrations after oral administration of paracetamol to patients with surgical resection of the gastrointestinal tract. British Journal of Clinical Pharmacology 1995;39:330–332.

    CAS  PubMed  Google Scholar 

  30. Stone E, Leiter LA, Lambert JR, Silverberg JDH, Jeejeebhoy KN, Burrow GN. L-Thyroxine absorption in patients with short bowel. Journal of Clinical Endocrinology and Metabolism 1984;59:139–141.

    Article  CAS  PubMed  Google Scholar 

  31. Roberts R, Sketris IS, Abraham I, Givner ML, MacDonald AS. Ciclosporine absorption in two patients with short-bowel syndrome. Drug Intelligence and Clinical Pharmacy 1988;22:570–572.

    CAS  PubMed  Google Scholar 

  32. Theilke J, Weber FL, Schroeder TJ, Goretsky S, Hanto DW. Pharmacokinetics of tacrolimus and cyclosporine in short-bowel syndrome. Liver Transplantation and Surgery 1998;4:432–434.

    Article  Google Scholar 

  33. Mindel A, Carney O. Acyclovir malabsorption. British Medical Journal 1988;296:1605.

    Article  CAS  PubMed  Google Scholar 

  34. Joe LA, Jacobs RA, Guglielmo BJ. Systemic absorption of oral fluconazole after gastrointestinal resection [letter]. Journal of Antimicrobial Chemotherapy 1994;33:1070.

    Article  CAS  PubMed  Google Scholar 

  35. Nahata MC, Freimer N, Hilty MD. Decreased absorption of cefaclor in short bowel syndrome. Drug Intelligence and Clinical Pharmacy 1983;17:201–202.

    CAS  PubMed  Google Scholar 

  36. Menardi G, Guggenbichler JP. Bioavailability of oral antibiotics in children with short-bowel syndrome. Journal of Paediatric Surgery 1984;19:84–86

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Pharmacy Department, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK

    Nicola Ward

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  1. Nicola Ward
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Correspondence to Nicola Ward.

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Ward, N. The Impact of Intestinal Failure on Oral Drug Absorption: A Review. J Gastrointest Surg 14, 1045–1051 (2010). https://doi.org/10.1007/s11605-009-1151-9

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  • DOI: https://doi.org/10.1007/s11605-009-1151-9

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