China
Africa
Explore chapters and articles related to this topic
Intrahepatic Cholestasis of Pregnancy
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Mechanism of action for ursodiol, which is a hydrophilic bile acid that inhibits intestinal absorption of other bile acids, enhances excretory hepatocyte function and choleretic activity, stabilizes hepatocyte cell membranes and dilutes toxic bile acids in the enterohepatic circulation [13]. Ursodiol may also allow for transport of bile acids out of fetal compartment. After treatment, ursodeoxycholic acid (UDCA) becomes the main component of the total bile acid measurement, thus reducing the proportion of cholic acid, that has been repeatedly implicated in the pathogenesis of fetal complications [21].
Gastrointestinal Aspects of Eating Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Bruce D. Waldholtz, Arnold E. Andersen
Gallstones likewise may be a complication of weight loss from dieting although the incidence in anorexia is not known and, if present, may be coincidental (45). Actigall (Ursodiol) may prevent gallstones with rapid weight loss, but the routine use of this agent could not be recommended (25).
Investigation and management of recurrent cholestasis of pregnancy
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
Various medications have been used in cholestasis of pregnancy. The drugs that have been used for pruritis include antihistaminics like chlorphenamine that help alleviate the itching by causing sedation at night. Cholestyramine, a bile acid chelating agent, helps improve pruritis but increases vitamin K deficiency. Activated charcoal and guar gum are not helpful. In addition, S-adenosyl methionine (SAMe) has not been found to be useful in relieving itching or improving perinatal outcome. The reports of usefulness of dexamethasone are controversial and not recommended. Other drugs like rifampicin and metformin have been reportedly used as adjunctive medications for ICP that are refractory to ursodiol alone [31].
Treatment options for neonatal infections in the post-cefotaxime era
Published in Expert Review of Anti-infective Therapy, 2022
Susannah Franco, Daniel Rampersad, Daniel Mesa, Margaret R. Hammerschlag
Risk of biliary pseudolithiasis is thought to be increased in neonates, who have decreased enteral nutrition, decreased bile excretion, decreased kidney function, hypoalbuminemia, and calcium-containing total parenteral nutrition (TPN) or fluids [16,19], but high-quality data is lacking. A systematic review by Cuzzolin et al. [16] found only one neonate among 25 pediatric case reports between 1980 and 2019 describing ceftriaxone-associated pseudolithiasis. The patient was a 28-day-old infant with an epidural hematoma who received 3 days of intravenous ceftriaxone at a dose of 100 mg/kg and experienced asymptomatic biliary sludge that resolved after cessation of therapy and administration of ursodiol at 10 mg/kg daily [16]. In general, data suffer from low external validity, inconsistent outcome measures, lack of comparators, and small sample sizes made up of homogenous and low-risk neonates [16,18].
Patient initiation and maintenance of GLP-1 RAs for treatment of obesity: a narrative review and practical considerations for primary care providers
Published in Postgraduate Medicine, 2021
Angela Fitch, Amy Beth Ingersoll
Substantial or rapid weight reduction, such as that observed with liraglutide 3.0 mg, has also been linked to an increased risk of gallbladder problems [49]. Furthermore, the incidence of acute gallbladder disease was greater in liraglutide-treated than in placebo-treated patients even after accounting for the degree of weight reduction. Liraglutide 3.0 mg was associated with a higher incidence of cholelithiasis and cholecystitis compared to placebo (2.2% vs 0.8%, and 0.8% vs 0.4%, respectively) [49]. To prevent the development of gallbladder complications, patients should be monitored regularly, with ultrasound for documenting gallstone disease performed on those with symptoms. For patients with known stone disease, counseling on precautions to limit the worsening of symptoms and further stone formation (e.g. amount of fat in the diet, use of ursodiol) should be used. The majority of patients with AEs of cholelithiasis and cholecystitis required cholecystectomy [49].
Assessing and managing symptom burden and quality of life in primary sclerosing cholangitis patients
Published in Expert Opinion on Orphan Drugs, 2021
Josiah D. McCain, David M. Chascsa, Keith D. Lindor
Furthermore, lack of an approved treatment means that studies aiming to treat the disease are left without a comparative arm other than the natural history of the disease itself, which makes trial design difficult. Attempts to use agents such as ursodiol, arguably the most important agent in modifying the disease course of those with PBC, has actually led to worse outcomes in patients with PSC, at least in high doses, suggesting that hepatotoxicity from the accumulation of toxic bile acids as damage to biliary cells progresses is not the whole story. Absence of a clear understanding of the pathological mechanism has meant, in a sense, educated guessing with regard to which therapies would be beneficial. To date, targeting the immune system through immune-system down-regulation and immunosuppression has failed to produce consistently meaningful results. Nonspecific immune system modulation such as the use of anti-inflammatories or corticosteroids, and even gastrointestinal specific agents such as vedolizumab likewise have not shown a meaningful change in disease progression.