Successful Use of Prucalopride Succinate in Cystic Fibrosis Acute Refractory Constipation Episode
Bibliographic record
Abstract
Purpose: Prucalopride succinate is an enterokinetic of a new class, the dihydrobenzofurancarboxamide, with high affinity for 5-HT4 receptor. Its main action is to stimulate myenteric neurons to release acetylcholine, calcitonin gene related-peptide, and azote monoxide which result in an increase of intestinal contractility and peristalsis. This medication was proven efficient to treat chronic idiopathic constipation in three randomized-controlled trials. Considering the effects of prucalopride succinate on digestive motility, other utilizations come to mind. However, few case reports for other indications have been published. We used prucalopride in a 32-year-old female suffering from acute refractory constipation. She was known for cystic fibrosis (homozygote F508) with bronchiectasis, exocrine and endocrine pancreatic insufficiency. She was recently hospitalized for a pulmonary superinfection for which she received ciprofloxacin 600 mg IV q8h, ceftazidime 2 g IV q8h, and colistimethate 100 mg IV q8h. She also received Rivotril® 1 mg PO hs, Dilaudid® 1 mg s/c q3h PRN, and Pancrease® MT-10 15 oral capsules with meal and 5 oral capsules with snack. During her hospitalization, she developed abdominal distension with no pain or nausea after having no bowel movement for 8 days. Serum electrolytes were normal, Dilaudid was stopped and abdominal x-ray showed severe stercoral stasis without dilatation or signs of perforation. In the next 4 days, she received intensive treatment for her constipation which included docusate 200 mg PO bid, sennosides 8.6 mg 2 tabs bid, polyethylene glycol 3350 17 g PO bid, lactulose 30 ml PO qd, 2 Fleet® Phospho-soda® IR, 8.5 liters of Golytely® (150 ml PO tid, 2L PO qd for 2 consecutive days then 4 liters in a day), and high doses subcutaneous methylnaltrexone, without any benefits. On the twelfth day, the patient received prucalopride succinate 2 mg PO with Golytely 4 liters. She had her first bowel movements in the hours following her only dose of prucalopride. This resulted in great symptomatic relief of her abdominal distension, without any side effect. Two days after, she was back on her regular regimen for constipation without recurrence of acute problematic constipation. In conclusion, prucalopride succinate was efficient in treating this case of acute refractory constipation in a young cystic fibrosis female patient. Cystic fibrosis patient frequently encountered difficult to treat constipation, and considering the efficacy and safety profile of prucalopride, this medication is another therapeutic option to use on top of a peg based-regimen for refractory cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".