Do Muscarinic Receptors Play a Role in Acute Pancreatitis?A Randomised Comparison of Pirenzepine and Nasogastric Suction

摘要

ObjectiveIn a previous clinical trial, we reported the potential usefulness of pirenzepine, a selective muscarinic M1cholinergic receptor antagonist, in the treatment of acute pancreatitis. The aim of this study is to extend these results to determine the comparative efficacy and tolerability of pirenzepine and nasogastric suction in the treatment of acute pancreatitis.DesignProspective, randomised, comparative clinical trial.SettingUniversity hospital.Patients50 consecutive patients admitted to the emergency room with acute pancreatitis diagnosed by abdominal pain and serum amylase levels higher than 700 IU/L or urine amylase levels higher than 1800 IU/L.InterventionsPatients received treatment with nasogastric suction or pirenzepine (10mg every 12 hours intravenously followed by 50mg every 12 hours orally once oral intake had resumed).Main Outcome MeasuresSerum and urine amylase levels and clinical symptoms.ResultsBasal clinical and biochemical parameters were similar between the two treatment groups. Pirenzepine significantly decreased the duration of hyperamylasaemia and hyperamylasuria, and the time to resumption of bowel sounds, passage of first faeces and clinical recovery compared with nasogastric suction. Pirenzepine was well tolerated and there were no differences between the two groups in the incidence of complications associated with acute pancreatitis.ConclusionsThe use of pirenzepine in acute pancreatitis has proved to be more beneficial in shortening the recovery period than nasogastric suction and thus may be a more beneficial alternative in these patients. The results of this trial reinforce our thinking that selective muscarinic M1-receptor antagonists warrant evaluation in further studies to define their efficacy and tolerability in patients with acute pancreatitis.