Effect of Acetaminophen Versus Ibuprofen in Treating Recurrent Apthous Ulcers in Pediatric Celiac Disease
Status:
Not yet recruiting
Trial end date:
2024-12-01
Target enrollment:
Participant gender:
Summary
Celiac disease (CD) is a chronic autoimmune enteropathy. It results from genetic
predisposition and exposure to gluten-containing food. Individuals carrying human leucocytes
antigen (HLA) markers DQ2 or DQ8 are genetically predisposed. Gluten is a protein found in
wheat, rye, and barley; the main ingredients of bread, pasta, and pastries. Gluten works as a
triggering factor for CD, but the interaction between genetic and environmental factors is
still not fully understood.
Celiac disease can alter the absorption of drugs. Due to its vast surface area compared with
the stomach, most drug absorption occurs in the small intestine and in celiac disease; the
surface area available for absorption is substantially reduced due to villous atrophy.
Patients with celiac disease develop a variety of gastric disorders requiring oral
medications, but the impact of damage to intestinal villi and other celiac disease squeal on
drug absorption remains poorly understood. A review of the pertinent literature
(English-language articles on research in adults published during the period 1970-August
2012) identified several reports of altered drug absorption mechanisms in patients with
celiac disease, including accelerated or delayed gastric emptying, increased permeability of
jejunal mucosa, changes in intraluminal pH, decreased intestinal surface area, and reduced
intestinal cytochrome P-450 enzymes. A small number of published studies suggest that celiac
disease may be associated with altered drug absorption, resulting in higher serum
concentrations of propranolol, lower peak concentrations of acetaminophen and practolol,
higher dosing requirements with levothyroxine, impaired or delayed absorption of certain
antibiotics, and other pharmacokinetic effects with a potential impact on medication efficacy
and toxicity. However, these studies involved very small patient samples and were poorly
controlled, with some yielding contradictory results. More and larger pharmacokinetic studies
in patients with celiac disease-especially studies of drugs that are dosed empirically or are
not amenable to dosage adjustment according to vital signs or laboratory values-are needed.