Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications. Drug classes that may be considered in the medical management of patients with postcholecystectomy syndrome include bulking agents, gastrointestinal (GI) antispasmodic agents, bile acid sequestrants, histamine H2 antagonists, and proton pump inhibitors (PPIs).
Bulking Agents
Class Summary
Bulking agents absorb water in the intestine to form viscous liquid that promotes peristalsis and reduces transit time.
Psyllium (Metamucil, Citrucel, Reguloid, Sorbulax)
Psyllium contains natural fiber that acts to increase the content of feces and, at the same time, promotes bacterial growth. The main indications for its use are in chronic constipation, irritable bowel syndrome, and bowel management in cases of patients with hemorrhoids.
Polycarbophil (Fiber-Lax, FiberCon, Konsyl Fiber)
Polycarbophil restores moisture levels and provides bulk in the patient's intestinal tract.
Antispasmodic Agents, Gastrointestinal
Class Summary
Some GI antispasmodic agents inhibit acetylcholine action, and this inhibition in turn inhibits salivation and secretions.
Atropine (Isopto Atropine)
Atropine blocks acetylcholine activity at parasympathetic sites in smooth muscles, the central nervous system, and secretory glands.
Diphenoxylate and atropine (Lomotil)
Diphenoxylate is an antidiarrheal agent chemically related to the narcotic analgesic meperidine. It acts on intestinal muscles to inhibit peristalsis and slow intestinal motility. It prolongs the movement of electrolytes and fluid through the bowel and increases viscosity and loss of fluids and electrolytes. A subtherapeutic dose of anticholinergic atropine sulfate is added to discourage overdosage, in which case diphenoxylate may clinically mimic the effects of codeine.
Bile Acid Sequestrants
Class Summary
Patients may benefit from bile acid sequestrants such as cholestyramine and colestipol.
Cholestyramine (Questran, Prevalite)
Cholestyramine may be used to treat diarrhea associated with excess bile acids. It binds bile acids, thus reducing damage to the intestinal mucosa. It also reduces the induction of colonic fluid secretion. It forms a nonabsorbable complex with bile acids in the intestine, which, in turn, inhibits enterohepatic reuptake of intestinal bile salts.
Colestipol (Colestid)
Colestipol forms a soluble complex after binding to bile acid, increasing fecal loss of bile acid–bound low-density lipoprotein cholesterol.
Histamine H2 Antagonists
Class Summary
Like antacids, H2-receptor antagonists do not reduce the frequency of reflux but do decrease the amount of acid in the refluxate by inhibiting acid production. All H2-receptor antagonists are equipotent when used in equivalent doses. They are most effective in patients with nonerosive esophagitis. H2-receptor antagonists are considered the drugs of choice for children because pediatric doses are well established and the medications are available in liquid form.
Nizatidine (Axid)
Nizatidine competitively inhibits histamine at the H2 receptor of the gastric parietal cells, resulting in reductions in gastric acid secretion, gastric volume, and hydrogen concentrations.
Cimetidine (Tagamet)
Cimetidine inhibits histamine at the H2 receptors of gastric parietal cells, causing reductions in gastric acid secretion, gastric volume, and hydrogen ion concentrations.
Ranitidine (Zantac)
Ranitidine inhibits histamine stimulation of the H2 receptor in gastric parietal cells, reducing gastric acid secretion, gastric volume, and hydrogen ion concentrations.
Famotidine (Pepcid)
Proton Pump Inhibitors
Class Summary
PPIs are indicated in patients who require complete acid suppression (eg, infants with chronic respiratory disease or neurologic disabilities). They should be administered with the first meal of the day. Children with nasogastric or gastrostomy tubes may have granules mixed with an acidic juice or a suspension; tubes must then be flushed to prevent blockage.
Lansoprazole (Prevacid)
Lansoprazole suppresses gastric acid secretion through specific inhibition of the H+/K+ -adenosine triphosphatase (ATPase) enzyme system (ie, proton pump) at the secretory surface of the gastric parietal cell. The drug blocks the final step of acid production, inhibiting basal and stimulated gastric acid secretion and therefore increasing gastric pH. Lansoprazole's effect is dose-related. The drug is easy to administer to children because it is available as a capsule or an oral disintegrating tablet or in granular form for use in an oral suspension.
Omeprazole (Prilosec)
Omeprazole decreases gastric acid secretion by inhibiting the parietal cell H+/K+ -ATPase pump. It is used for both short-term treatment (4-8 weeks) and long-term treatment (up to 12 months) of gastroesophageal reflux disease.
Esomeprazole (Nexium)
Esomeprazole is an (S)-isomer of omeprazole. It inhibits gastric acid secretion by inhibiting the H+/K+ -ATPase enzyme system at the secretory surface of the gastric parietal cells. Esomeprazole is used in severe cases and in patients not responding to H2-antagonist therapy. The drug is administered for up to 4 weeks to treat and relieve the symptoms of active duodenal ulcers; it may be used for up to 8 weeks to treat all grades of erosive esophagitis.
Dexlansoprazole (Dexilant)
Dexlansoprazole suppresses gastric acid secretion by specifically inhibiting the H+/K+ -ATPase enzyme system at the secretory surface of gastric parietal cells.
Rabeprazole sodium (Aciphex)
Rabeprazole sodium suppresses gastric acid secretion by specifically inhibiting the H+/K+ -ATPase enzyme system at the secretory surface of gastric parietal cells.
Pantoprazole (Protonix)
Pantoprazole suppresses gastric acid secretion by specifically inhibiting the H+/K+ -ATPase enzyme system at the secretory surface of gastric parietal cells.
Tables
Anatomy |
Etiology |
Gallbladder remnant and cystic duct |
Residual or reformed gallbladder Stump cholelithiasis Neuroma |
Liver |
Fatty infiltration of liver Hepatitis Hydrohepatosis Cirrhosis Chronic idiopathic jaundice Gilbert disease Dubin-Johnson syndrome Hepatolithiasis Sclerosing cholangitis Cyst |
Biliary tract |
Cholangitis Adhesions Trauma Cyst Malignancy and cholangiocarcinoma Choledocholithiasis Dilation without obstruction Hypertension or nonspecific dilation Dyskinesia Fistula |
Periampullary |
Sphincter of Oddi dyskinesia, spasm, or hypertrophy Sphincter of Oddi stricture Papilloma Cancer |
Pancreas |
Pancreatic stone Pancreatic cysts Benign tumors |
Esophagus |
Aerophagia Achalasia |
Stomach |
Bile gastritis Peptic ulcer disease Gastric cancer |
Duodenum |
Adhesions |
Small bowel |
Adhesions Incisional hernia |
Colon [5] |
Diarrhea Incisional hernia Irritable bowel disease |
Vascular |
Intestinal angina Coronary angina |
Nerve |
Neuroma Intercostal neuralgia Spinal nerve lesions Sympathetic imbalance Neurosis Psychic tension or anxiety |
Bone |
Arthritis |
Other |
20% organ other than hepatobiliary or pancreatic Foreign bodies, including gallstones and surgical clips |
