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Three ileus cases associated with the use of dipeptidyl peptidase-4 inhibitors in diabetic patients.

Kanasaki K, Konishi K, Hayashi R, Shiroeda H, Nomura T, Nakagawa A, Nagai T, Takeda-Watanabe A, Ito H, Tsuda S, Kitada M, Fujii M, Kanasaki M, Nishizawa M, Nakano Y, Tomita Y, Ueda N, Kosaka T, Koya D - J Diabetes Investig (2013)

Bottom Line: Dipeptidyl peptidase (DPP)-4 inhibitors are a new class of antidiabetic drugs that increase incretin hormone levels to enhance blood sugar level-dependent insulinotropic effects, suppress glucagon action, and reduce bowel motility.These incretin effects are ideal for blood sugar control.The use of a DPP-4 inhibitor could be safe, although the cases presented herein enable us to inform the scientific community to some of the potential adverse effects of the use of DPP-4 inhibitors in select populations.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetology and Endocrinology Kanazawa Medical University Ishikawa Japan.

ABSTRACT
Dipeptidyl peptidase (DPP)-4 inhibitors are a new class of antidiabetic drugs that increase incretin hormone levels to enhance blood sugar level-dependent insulinotropic effects, suppress glucagon action, and reduce bowel motility. These incretin effects are ideal for blood sugar control. However, the safety profile of DPP-4 inhibitors is not yet established. Herein, we present three cases of ileus, considered to be closely related to the use of DPP-4 inhibitors, in diabetic patients. Each of the three patients exhibited some risk of a deficiency in bowel movement; the onset of ileus was within 40 days after strengthened inhibition of DPP-4. The use of a DPP-4 inhibitor could be safe, although the cases presented herein enable us to inform the scientific community to some of the potential adverse effects of the use of DPP-4 inhibitors in select populations.

No MeSH data available.


Related in: MedlinePlus

Results of abdominal X‐ray and computed tomography (CT) imaging in Case 2. An upright abdominal X‐ray (a) and CT scan (b) demonstrate small bowel obstruction. Note that multiple air–fluid levels can be seen in both panels.
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jdi12095-fig-0001: Results of abdominal X‐ray and computed tomography (CT) imaging in Case 2. An upright abdominal X‐ray (a) and CT scan (b) demonstrate small bowel obstruction. Note that multiple air–fluid levels can be seen in both panels.

Mentions: The second patient was a 61‐year‐old Japanese woman with myeloperoxidase anti‐neutrophil cytoplasmic antibody (ANCA)‐positive rapidly progressive glomerulonephritis being treated with prednisolone. The patient was in a stable condition (estimated glomerular filtration rate [eGFR] 29 mL/min per 1.73 m2). The patient had undergone surgery for early gastric cancer (IIc) 25 years previously. She had a >10‐year history of type 2 diabetes and her diabetes had been treated with mitiglinide and sitagliptin; miglitol (150 mg/day) was added to her antidiabetes regimen to control post‐prandial hyperglycemia, and the sitagliptin was discontinued. The patient's average HbA1c over 6 months was 7.7% (NGSP4). The patient refused insulin and had been treated instead with a half‐dose of vildagliptin (50 mg/day) in addition to mitiglinide (30 mg/day) and miglitol (225 mg/day) for 4 months. The patient's prednisolone dose was decreased to 10 mg/day (from 15 mg/day) and she was eventually prescribed a full dose of alogliptin (25 mg/day) instead of vildagliptin (50 mg/day). Thirty‐eight days later, she experienced intermittent abdominal pain and vomiting. She had experienced difficulty in emptying her bowel for the past month. She was identified with air–fluid levels in her colon and was admitted to the surgical unit for further assessment. X‐Ray and CT imaging indicated that her ileus was becoming worse (Figure 1). Gastrointestinal decompression was performed via a nasoenteric tube; however, this was not effective. So, 3.5 days later, surgical decompression and reconstructive surgery were performed for a collapsed small intestine, which revealed an internal hernia.


Three ileus cases associated with the use of dipeptidyl peptidase-4 inhibitors in diabetic patients.

Kanasaki K, Konishi K, Hayashi R, Shiroeda H, Nomura T, Nakagawa A, Nagai T, Takeda-Watanabe A, Ito H, Tsuda S, Kitada M, Fujii M, Kanasaki M, Nishizawa M, Nakano Y, Tomita Y, Ueda N, Kosaka T, Koya D - J Diabetes Investig (2013)

Results of abdominal X‐ray and computed tomography (CT) imaging in Case 2. An upright abdominal X‐ray (a) and CT scan (b) demonstrate small bowel obstruction. Note that multiple air–fluid levels can be seen in both panels.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020265&req=5

jdi12095-fig-0001: Results of abdominal X‐ray and computed tomography (CT) imaging in Case 2. An upright abdominal X‐ray (a) and CT scan (b) demonstrate small bowel obstruction. Note that multiple air–fluid levels can be seen in both panels.
Mentions: The second patient was a 61‐year‐old Japanese woman with myeloperoxidase anti‐neutrophil cytoplasmic antibody (ANCA)‐positive rapidly progressive glomerulonephritis being treated with prednisolone. The patient was in a stable condition (estimated glomerular filtration rate [eGFR] 29 mL/min per 1.73 m2). The patient had undergone surgery for early gastric cancer (IIc) 25 years previously. She had a >10‐year history of type 2 diabetes and her diabetes had been treated with mitiglinide and sitagliptin; miglitol (150 mg/day) was added to her antidiabetes regimen to control post‐prandial hyperglycemia, and the sitagliptin was discontinued. The patient's average HbA1c over 6 months was 7.7% (NGSP4). The patient refused insulin and had been treated instead with a half‐dose of vildagliptin (50 mg/day) in addition to mitiglinide (30 mg/day) and miglitol (225 mg/day) for 4 months. The patient's prednisolone dose was decreased to 10 mg/day (from 15 mg/day) and she was eventually prescribed a full dose of alogliptin (25 mg/day) instead of vildagliptin (50 mg/day). Thirty‐eight days later, she experienced intermittent abdominal pain and vomiting. She had experienced difficulty in emptying her bowel for the past month. She was identified with air–fluid levels in her colon and was admitted to the surgical unit for further assessment. X‐Ray and CT imaging indicated that her ileus was becoming worse (Figure 1). Gastrointestinal decompression was performed via a nasoenteric tube; however, this was not effective. So, 3.5 days later, surgical decompression and reconstructive surgery were performed for a collapsed small intestine, which revealed an internal hernia.

Bottom Line: Dipeptidyl peptidase (DPP)-4 inhibitors are a new class of antidiabetic drugs that increase incretin hormone levels to enhance blood sugar level-dependent insulinotropic effects, suppress glucagon action, and reduce bowel motility.These incretin effects are ideal for blood sugar control.The use of a DPP-4 inhibitor could be safe, although the cases presented herein enable us to inform the scientific community to some of the potential adverse effects of the use of DPP-4 inhibitors in select populations.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetology and Endocrinology Kanazawa Medical University Ishikawa Japan.

ABSTRACT
Dipeptidyl peptidase (DPP)-4 inhibitors are a new class of antidiabetic drugs that increase incretin hormone levels to enhance blood sugar level-dependent insulinotropic effects, suppress glucagon action, and reduce bowel motility. These incretin effects are ideal for blood sugar control. However, the safety profile of DPP-4 inhibitors is not yet established. Herein, we present three cases of ileus, considered to be closely related to the use of DPP-4 inhibitors, in diabetic patients. Each of the three patients exhibited some risk of a deficiency in bowel movement; the onset of ileus was within 40 days after strengthened inhibition of DPP-4. The use of a DPP-4 inhibitor could be safe, although the cases presented herein enable us to inform the scientific community to some of the potential adverse effects of the use of DPP-4 inhibitors in select populations.

No MeSH data available.


Related in: MedlinePlus