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The Effects of Loperamide on Continence Problems and Anorectal Function in Obese Subjects Taking Orlistat

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Abstract

Continence problems during treatment with orlistat (a lipase inhibitor) are caused when susceptible patients are exposed to increased volumes of loose, fatty stool. Aim: To investigate the dose-response effects of loperamide on continence and anorectal function in subjects susceptible to continence problems on orlistat. Method: Ten obese subjects enterred a randomized controlled, double-blind study of loperamide at placebo, 2, 4, and 6 mg/day in a factorial design. Continence problems during orlistat treatment were self-assessed by patient diary. Anorectal function and continence were assessed by barostat, manometry, and retention testing. Results: Loperamide increased stool consistency with dose (p = 0.07) and this effect reduced continence problems during orlistat treatment (p < 0.05). A bell-shaped dose-response relationship was present with anal sphincter function (p < 0.01) and anorectal sensitivity (p < 0.01). Conclusion: Loperamide has beneficial effects on stool consistency and continence in obese subjects taking orlistat. The effect on stool consistency appeared more important than effects on anorectal function.

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References

  1. Zhi J, Melia AT, Guerciolini R, et al.: Retrospective population-based analysis of the dose-response (fecal fat excretion) relationship of orlistat in normal and obese volunteers. Clin Pharmacol Ther 56:82–85, 1994

    CAS  PubMed  Google Scholar 

  2. Sjostrom L, Rissanen A, Andersen T, et al.: Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet 352:167–172, 1998

    CAS  Google Scholar 

  3. Rossner S, Sjostrom L, Noack R, Meinders AE, Noseda G: Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. European Orlistat Obesity Study Group. Obes Res 8:49–61, 2000

    CAS  Google Scholar 

  4. Fox M, Thumshirn M, Menne D, Stutz B, Fried M, Schwizer W: The pathophysiology of faecal spotting in obese subjects during treatment with orlistat. Aliment Pharmacol Ther 19:311–321, 2004

    Article  CAS  PubMed  Google Scholar 

  5. Fox M, Schwizer W, Menne D, Stutz B, Fried M, Thumshirn M: The physical properties of rectal contents have effects on anorectal continence: Insights from a study into the cause of fecal spotting on orlistat. Dis Colon Rectum 47:4127–4136, 2004

    Article  Google Scholar 

  6. Heel R, Brogden R, Speight T, Avery G: Loperamide: A review of its pharmacological properties and therapeutic efficay in diarrhea. Drugs 15:33–52, 1978

    CAS  PubMed  Google Scholar 

  7. Schiller LR, Santa Ana CA, Morawski SG, Fordtran JS; Mechanism of the antidiarrheal effect of loperamide. Gastroenterology 86:1475–1480, 1984

    CAS  PubMed  Google Scholar 

  8. Kachel G, Ruppin H, Hagel J, Barina W, Meinhardt M, Domschke W: Human intestinal motor activity and transport: Effects of a synthetic opiate. Gastroenterology 90:85–93, 1986

    CAS  PubMed  Google Scholar 

  9. Lewis SJ, Heaton KW: Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32:920–924, 1997

    CAS  PubMed  Google Scholar 

  10. Spiller RC: Disturbances in large bowel motility. Baillieres Best Pract Res Clin Gastroenterol 13:397–413,1999

    Article  CAS  PubMed  Google Scholar 

  11. Pelemans W, Vantrappen F: A double blind crossover comparison of loperamide with diphenoxylate in the treatment of chronic diarrhea. Gastroenterology 70:1030–1034, 1976

    CAS  PubMed  Google Scholar 

  12. Palmer KR, Corbett CL, Holdsworth CD: Double-blind cross-over study comparing loperamide, codeine and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology 79:1272–1275, 1980

    CAS  PubMed  Google Scholar 

  13. Read M, Read NW, Barber DC, Duthie HL: Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency. Dig Dis Sci 27:807–814, 1982

    CAS  PubMed  Google Scholar 

  14. Emblem R, Stein R, Morkind L: The effect of loperamide on bowel habits and anal sphincter function in patients with ileoanal anastomosis. Scand J Gastroenterol 24:1019–1024, 1989

    CAS  PubMed  Google Scholar 

  15. Hallgren T, Fasth S, Delbro DS, Nordgren S, Oresland T, Hulten L: Loperamide improves anal sphincter function and continence after restorative proctocolectomy. Dig Dis Sci 39:2612–2618, 1994

    Article  CAS  PubMed  Google Scholar 

  16. Sun WM, Read NW, Verlinden M: Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence. Scand J Gastroenterol 32:34–38, 1997

    CAS  PubMed  Google Scholar 

  17. Whitehead WE, Delvaux M: Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. The Working Team of Glaxo-Wellcome Research, UK. Dig Dis Sci 42:223–241, 1997

    Google Scholar 

  18. Fox M, Menne D, Fried M, Schwizer W, Thumshirn M: The measurement of rectal capacity by barostat techniques. Gut 52 (Suppl VI):A91, 2003

    Google Scholar 

  19. Jones OM, Brading AF, Mortensen NJ: The physiology, pharmacology and therapeutic manipulation of the internal anal sphincter. Can J Gastroenterol 16:249–257, 2002

    PubMed  Google Scholar 

  20. Bass DD, Ustach TJ, Schuster MM: In vitro pharmacologic differentiation of sphincteric and non-sphincteric muscle. Johns Hopkins Med J 127:185–191, 1970

    CAS  PubMed  Google Scholar 

  21. Fox M, Thumshirn M, Menne D, Fried M, Schwizer W: Anal sphincter pressure and rectal capacity affect anorectal sensation and continence in health. Gastroenterology 126:A1578, 2004

    Google Scholar 

  22. Cavaliere H, Floriano I, Medeiros-Neto G: Gastrointestinal side effects of orlistat may be prevented by concomitant prescription of natural fibers (psyllium mucilloid). Int J Obes Relat Metab Disord 25:1095–1099, 2001

    Article  CAS  PubMed  Google Scholar 

  23. Kaplan MA, Prior MJ, Ash RR, McKonly KI, Helzner EC, Nelson EB: Loperamide-simethicone vs loperamide alone, simethicone alone, and placebo in the treatment of acute diarrhea with gas-related abdominal discomfort. A randomized controlled trial. Arch Fam Med 8:243–248, 1999

    CAS  Google Scholar 

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Correspondence to Mark Fox MD.

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Fox, M., Stutz, B., Menne, D. et al. The Effects of Loperamide on Continence Problems and Anorectal Function in Obese Subjects Taking Orlistat. Dig Dis Sci 50, 1576–1583 (2005). https://doi.org/10.1007/s10620-005-2900-6

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  • DOI: https://doi.org/10.1007/s10620-005-2900-6

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