Gastroenterology
Chronic Pancreatitis
Summary
- 38 year old incarcerated female patient
- History of hypertriglyceridemia and chronic pancreatitis
- PCP seeking treatment recommendations for severe abnominal pain
eConsult Transcript
PCP submission
This is a 38 yo incarcerated female with a history of severe hypertriglyceridemia and chronic pancreatitis. TG’s have been >3000 with frequent admissions for pancreatitis. In August 2024 she was admitted with abdominal pain and was found to have a bowel obstruction, possibly from a perforation at a recent colonoscopy. She underwent a partial colectomy with primary anastomosis. She has done well since, but is extremely constipated. In fact sent back to ED recently for severe abd pain and had a CT scan done which was negative except for stool burden. She takes Miralax daily without relief. No BM for a week. What treatment would you recommend?
Specialist response
That is a great question. I typically start out with MiraLAX and other laxatives initially, when those become less effective or if they are less effective then I move right on to Linzess; In this case, given the amount of previous laxatives she was needing, I would start with a dose of Linzess, 290 µg daily. I typically start out with Linzess, it is very safe, it is not absorbed into the blood, there is no measurable blood levels of the drug and are safe in most adult patients. I would keep her on this higher dose for 2 to 3 weeks, sometimes they keep patients on the dose for up to eight weeks. If she has a significant amount of loose stool with this higher dose, can’t go down to the lower dose, either 145 mcg or 72 mcg daily. This has FDA approved indication for chronic idiopathic constipation of which there are about 8 million Americans that live with this and for IBS with constipation Of which there are about 2 million Americans that live with this. Another option would be Trulance 3 mg daily (FDA approved for chronic idiopathic constipation and IBS with constipation) or Amitiza 24 micrograms twice daily (FDA approved for chronic idiopathic constipation, IBS with constipation and opioid induced constipation). I will typically try these if insurance doesn’t cover the Linzess or if they fail Linzess. They are all very good options. I hope this helps. Thanks
