Absorption and efficacy of acetylsalicylic acid in patients with short bowel syndrome.

BACKGROUND: The patients with a short bowel (SB) frequently require antiplatelet therapy. Resection of the bowel is likely to modify the absorption and first-pass effect of drugs. No data on the absorption and efficacy of the cardiovascular dose of aspirin (75-160 mg) in these patients have been published. OBJECTIVE: To evaluate the efficacy of a low dose of aspirin in patients with SB caused by mesenteric ischemia. METHODS: The efficacy of a low dose of aspirin was assessed in 10 consecutive SB patients, both 1 hour and 24 hours after administration (peak and trough value, respectively). The primary criterion was the inhibition of platelet aggregation, as assessed by light transmission aggregometry, triggered with 0.5 mg/mL arachidonic acid. Biological efficacy of aspirin was also evaluated by serum thromboxane B2 value and by platelet function analyzer-100. RESULTS: At its peak value, aspirin had the expected efficacy, as demonstrated both by light transmission aggregometry and the other methods. However, 24 hours after administration, as many as 30% of patients had lost the pharmacological efficacy of their aspirin. CONCLUSION: We show for the first time that with at least 30 cm of small intestine, all patients with SB absorb sufficient oral aspirin in a cardiovascular dose to rapidly exert the expected level of antiplatelet activity. But given only once daily, aspirin does not provide stable 24-hour antiplatelet protection in 30% of patients, because of increased platelet turnover, as usually observed in patients with extensive vascular pathology, diabetes, or inflammation.

[Use of oral drugs and short bowel syndrome: an analysis of practices]. / Utilisation des médicaments par voie orale et syndrome de grêle court : analyse des pratiques.

OBJECTIVE: To describe drug prescription patterns in patients with short bowel syndrome (SBS). METHODS: The drug prescriptions of patients suffering from SBS type 1 to 3 were compared. RESULTS: Seventy-nine percent of the drugs were prescribed by oral route, and this proportion was significantly higher in patients with type 3 compared to tose with type 1. Twenty-nine percent of prescriptions were dietary supplement-drugs, 14.3% were gastrointestinal drugs and 11.4% were cardiovascular drugs. Oral prescription medications for SBS concerned many drug categories. The number of gastrointestinal or dietary supplement drugs was comparable between the 3 types. Drug doses were not increased compared with the recommendations, except for gastrointestinal drugs. CONCLUSION: The oral administration is common and at usual dosage in patients with SBS despite a lack of studies on absorption that may help to individualize drug prescription.

Antidepressant agents in short bowel syndrome.

PURPOSE: This study aimed to determine whether short small intestine modifies antidepressant concentrations. METHODS: The Css values and concentration-dose ratios (CDRs) of citalopram or escitalopram, administered orally or intravenously, were determined in patients with short bowel syndrome. FINDINGS: Eight patients (6 males and 2 females) were included in the study. High CDRs were obtained in orally treated patients with >180 cm of small bowel and in those with >80 cm of small bowel and 50% of colon. Three patients had low Css values, including 1 patient who received intravenous treatment. IMPLICATIONS: The variability of drug absorption and metabolism makes prescribing SSRIs challenging in these patients.