Clinical Pharmacological Considerations

  • C. J. C. Roberts
Part of the Treatment in Clinical Medicine book series (TC MEDICINE)


Within the practice of the gastroenterologist there will be patients suffering from diseases of the alimentary tract and of the pancreas and hepatobiliary systems. The alimentary tract provides the portal of entry of most drugs and the liver is a major organ of their elimination; physiological alterations in gastrointestinal function and disease processes may therefore be expected to have a profound influence on the pharmacokinetics and actions of drugs. Therapy for conditions outside the gastrointestinal tract can be affected by gastrointestinal disturbance. Gastrointestinal disease not only influences drug action through altered absorption or elimination: alterations in body composition as a result of nutritional deficit or hepatic disease may also cause variations in the distribution characteristics of certain drugs which in turn may require changes in dose or dose interval. Both the liver and the alimentary tract provide important sites of drug interaction, and disease in these organs may affect the extent and significance of any such interaction. The liver is particularly sensitive to adverse drug effects, so that iatrogenic disease forms a significant proportion of any gastroenterologist’s practice. Thus although the gastroenterologist uses specific drug therapy less frequently than do other specialists, he must always be aware firstly that the patient’s disorder may be the result of previous medication and secondly that drug therapy of cardiovascular, respiratory, CNS or other types of disease may need to be adjusted in the presence of concurrent or intercurrent gastrointestinal disease. The aim of this chapter is to explore the special relationship of the alimentary tract and liver to clinical pharmacokinetics and drug action, and to provide examples of situations in which altered gastrointestinal function requires care in therapy for conditions outside the gastrointestinal tract.


Gastric Emptying Clinical Pharmacokinetic Coeliac Disease Alimentary Tract Hepatic Blood Flow 
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Further Reading

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Copyright information

© Springer-Verlag Berlin Heidelberg 1983

Authors and Affiliations

  • C. J. C. Roberts

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