Do muscarinic receptors play a role in acute pancreatitis? A randomised comparison of pirenzepine and nasogastric suction

Objective: In a previous clinical trial, we reported the potential usefulne ss of pirenzepine, a selective muscarinic M-1 cholinergic receptor antagoni st, in the treatment of acute pancreatitis. The aim of this study is to ext end these results to determine the comparative efficacy and tolerability ol f pirenzepine and nasogastric suction in the treatment of acute pancreatiti s. Design: Prospective, randomised, comparative clinical trial. Setting: University hospital. Patients: 50 consecutive patients admitted to the emergency room with acute pancreatitis diagnosed by abdominal pain and serum amylase levels higher t han 700 IU/L or urine amylase levels higher than 1800 IU/L. Interventions: Patients received treatment with nasogastric suction or pire nzepine (10mg every 12 hours intravenously followed by 50mg every 12 hours orally once oral intake had resumed). Main Outcome Measures: Serum and urine amylase levels and clinical symptoms . Results: Basal clinical and biochemical parameters were similar between t he two treatment groups. Pirenzepine significantly decreased the duration o f hyperamylasaemia and hyperamylasuria, and the time to resumption of bowel sounds, passage of first faeces and clinical recovery compared with nasoga stric suction. Pirenzepine was well tolerated and there were no differences between the two groups in the incidence of complications associated with a cute pancreatitis. Conclusions: The 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 result s of this trial reinforce our thinking that selective muscarinic Mt-recepto r antagonists warrant evaluation in further studies to define their efficac y and tolerability in patients with acute pancreatitis.