title: The effects of loperamide on continence problems and anorectal function in obese subjects taking orlistat.
abstract: Continence problems during treatment with orlistat (a lipase inhibitor) are caused when susceptible patients are exposed to increased volumes of loose, fatty stool.
  
  
  OBJECTIVE
  To investigate the dose-response effects of loperamide on continence and anorectal function in subjects susceptible to continence problems on orlistat.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, St. Thomas' Hospital, London, UK. mark.fox@doctors.org.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Fox
authors.forename: Bernadette
authors.initials: B
authors.lastname: Stutz
authors.forename: Dieter
authors.initials: D
authors.lastname: Menne
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Werner
authors.initials: W
authors.lastname: Schwizer
authors.forename: Miriam
authors.initials: M
authors.lastname: Thumshirn
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000187:drug effects / Q000502:physiology; D019440:Anti-Obesity Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000930:Antidiarrheals / Q000494:pharmacology* / Q000627:therapeutic use*; D004311:Double-Blind Method; D005242:Fecal Incontinence / Q000139:chemically induced* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007783:Lactones / Q000009:adverse effects* / Q000627:therapeutic use*; D008139:Loperamide / Q000494:pharmacology* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy*; D000077403:Orlistat; D010919:Placebos; D012007:Rectum / Q000187:drug effects / Q000502:physiology
chemical_list: D019440:Anti-Obesity Agents; D000930:Antidiarrheals; D007783:Lactones; D010919:Placebos; D008139:Loperamide; D000077403:Orlistat