Gastrointestinal function in chronic radiation enteritis--effects of loperamide-N-oxide.
The effects of loperamide-N-oxide, a new peripheral opiate agonist precursor, on gastrointestinal function were evaluated in 18 patients with diarrhoea caused by chronic radiation enteritis. Each patient was given, in double-blind randomised order, loperamide-N-oxide (3 mg orally twice daily) and placebo for 14 days, separated by a washout period of 14 days. Gastrointestinal symptoms; absorption of bile acid, vitamin B12, lactose, and fat; gastric emptying; small intestinal and whole gut transit; and intestinal permeability were measured during placebo and loperamide-N-oxide phases. Data were compared with those obtained in 18 normal subjects. In the patients, in addition to an increased frequency of bowel actions (p < 0.001), there was reduced bile acid absorption, (p < 0.001) a higher prevalence of lactose malabsorption (p < 0.05) associated with a reduced dietary intake of dairy products (p < 0.02), and faster small intestinal (p < 0.001) and whole gut transit (p < 0.05) when compared with the normal subjects. There was no significant difference in gastric emptying between the two groups. Treatment with loperamide-N-oxide was associated with a reduced frequency of bowel actions (p < 0.001), slower small intestinal (p < 0.001), and total gut transit (p < 0.01), more rapid gastric emptying (p < 0.01), improved absorption of bile acid (p < 0.01), and increased permeability to 51Cr EDTA (p < 0.01). These observations indicate that: (1) diarrhoea caused by chronic radiation enteritis is associated with more rapid intestinal transit and a high prevalence of bile acid and lactose malabsorption, and (2) loperamide-N-oxide slows small intestinal transit, increases bile acid absorption, and is effective in the treatment of diarrhoea associated with chronic radiation enteritis.
Department of Radiation Oncology, Royal Adelaide Hospital, South Australia.
E K
EK
Yeoh
M
M
Horowitz
A
A
Russo
T
T
Muecke
T
T
Robb
B E
BE
Chatterton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003967:Diarrhea / Q000188:drug therapy* / Q000209:etiology; D004064:Digestive System / Q000503:physiopathology*; D004311:Double-Blind Method; D004751:Enteritis / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008139:Loperamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications* / Q000503:physiopathology; D011878:Radiotherapy / Q000009:adverse effects; D014565:Urogenital Neoplasms / Q000532:radiotherapy
D008139:Loperamide; C066043:loperamide oxide