Digestive Diseases and Sciences

, Volume 39, Issue 12, pp 2612–2618 | Cite as

Loperamide improves anal sphincter function and continence after restorative proctocolectomy

  • T. Hallgren
  • S. Fasth
  • D. S. Delbro
  • S. Nordgren
  • T. Öresland
  • L. Hultén
Motitity, Nerve-Gut Interactions, Hormones, And Receptors


The physiological and clinical effects of loperamide treatment versus placebo were investigated in a randomized, double-blind, crossover study in patients operated with restorative proctocolectomy. Sixteen patients operated with endoanal mucosectomy and a handsewn ileal pouch-anal anastomosis and 14 patients operated with abdominal proctocolectomy and stapling of the pouch to the top of the anal canal were studied. While loperamide treatment increased resting anal pressure in both groups of patients by approximately 20% (P<0.05), squeeze pressure was not affected. Loperamide did not affect pouch volume or contractility. Sensory thresholds and the recto/pouch-anal inhibitory reflex were not influenced by loperamide treatment. Clinical function was improved, with a reduced bowel frequency and an improved nighttime continence, with less soiling (P<0.05) as well as need to wear a protective pad.

Key words

anal sphincter continence loperamide manovolumetry restorative proctocolectomy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wexner SD, Jensen L, Rothenberger DA, Wong WD, Goldberg SM: Long-term functional analysis of the ileoanal reservoir. Dis Colon Rectum 32:275–281, 1989PubMedGoogle Scholar
  2. 2.
    Pemberton JH, Phillips SF, Ready RR, Zinsmeister AR, Bears OH: Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Ann Surg 209:620–628, 1989PubMedGoogle Scholar
  3. 3.
    Öresland T, Fasth S, Nordgren S, Hultén L: The clinical and functional outcome after restorative proctocolectomy. A prospective study in 100 patients. Int J Colorect Dis 4:50–56, 1989Google Scholar
  4. 4.
    Schiller LR, Santa Ana CA, Morawski SG, Fordtran JS: Mechanism of the antidiarrheal effect of loperamide. Gastroenterology 86:1475–1480, 1984PubMedGoogle Scholar
  5. 5.
    Theodorou V, Fioramonti J, Hachet T, Bueno L: Absorptive and motor components of the antidiarrhoeal action of loperamide: Anin vivo study in pigs. Gut 32:1355–1399, 1991PubMedGoogle Scholar
  6. 6.
    De Luca A, Coupar IM: Difenoxin and loperamide: Possible mechanisms of intestinal antisecretory action. Arch Pharmacol 347:231–237, 1993Google Scholar
  7. 7.
    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, 1982PubMedGoogle Scholar
  8. 8.
    Göke A, Ewe K, Donner K, Meyer zum Büschenfelde KH: Influence of loperamide and loperamide oxide on the anal sphincter. Dis Colon Rectum 35:857–861, 1992PubMedGoogle Scholar
  9. 9.
    Rattan S, Culver PJ: Influence of loperamide on the internal anal sphincter in the opossum. Gastroenterology 93:121–128, 1987PubMedGoogle Scholar
  10. 10.
    Hallgren T, Fasth S, Nordgren S, Öresland T, Hultén L: The stapled ileal pouch-anal anastomosis. A randomized study comparing two different pouch designs. Scand J Gastroenterol 25:1161–1168, 1990PubMedGoogle Scholar
  11. 11.
    Åkervall S, Fasth S, Nordgren S, Öresland T, Hultén L: Manovolumetry: A new method for investigation of anorectal function. Gut 29:614–623, 1988PubMedGoogle Scholar
  12. 12.
    Öresland T, Fasth S, Nordgren S, Åkervall S, Hultén L: Manovolumetric and sensory characteristics of the ileoanal J-pouch compared with healthy rectum. Br J Surg 77:803–806, 1990PubMedGoogle Scholar
  13. 13.
    Öresland T, Fasth S, Nordgren S, Hallgren T, Hultén L: A prospective randomized comparison of two different pouch designs. Scand J Gastroenterol 25:986–996, 1990PubMedGoogle Scholar
  14. 14.
    Ooms LAA, Degryse AD, Janssen PAJ: Mechanisms of action of loperamide. Scand J Gastroenterol 19:145–155, 1984PubMedGoogle Scholar
  15. 15.
    Hughes S, Higgs NB, Turnberg LA: Loperamide has antisecretory activityin vivo in human jejunum. Gut 24:A495, 1983Google Scholar
  16. 16.
    Kachel GW, Ruppin H, Hagel J, Barina W, Meinhard M, Domschke W: Effect of loperamide on jejunal fluid transport and propulsion in man. Gastroenterol 84:1200, 1983Google Scholar
  17. 17.
    Reynolds IJ, Gould RJ, Snyder SH: Loperamide: Blockade of calcium channels as a mechanism for antidiarrheal effects. J Pharmacol Exp Ther 231:628–632, 1984PubMedGoogle Scholar
  18. 18.
    Burleigh DE, D'Mello A: Neural and pharmacological factors affecting motility of the internal anal sphincter. Gastroenterology 84:409–417, 1983PubMedGoogle Scholar
  19. 19.
    McKirdy HC: Effect of loperamide on human isolated internal anal sphincter. J Physiol 316:18, 1981Google Scholar
  20. 20.
    Emblem R, Stien R, Mörkrid L: The effect of loperamide on bowel habits and anal sphincter function in patients with ileoanal anastomosis. Scand J Gastroenterol 24:1019–1024, 1989PubMedGoogle Scholar
  21. 21.
    Yagasaki O, Suzuki H, Sohji Y: Effects of loperamide on acetylcholine and prostaglandin release from isolated guinea pig ileum. Jpn J Pharmacol 28:873–882, 1978PubMedGoogle Scholar
  22. 22.
    Musial F, Enck P, Kalveram K-T, Erckenbrecht JF: The effect of loperamide on anorectal function in normal healthy men. J Clin Gastroenterol 15:321–324, 1992PubMedGoogle Scholar
  23. 23.
    Orkin BA, Soper NJ, Kelly KA, Dent J: Influence of sleep on anal sphincteric pressure in health and after ileal pouchanal anastomosis. Dis Colon Rectum 35:137–144, 1992PubMedGoogle Scholar
  24. 24.
    Duthie GS, Bartolo DCC: Nocturnal leakage is related to high pressure waves following restorative proctocolectomy. Br J Surg 77:A699-A700, 1990Google Scholar
  25. 25.
    Hallgren T, Fasth S, Delbro D, Nordgren S, Öresland T, Hultén L: The effects of atropine or benzilonium on pelvic pouch and anal sphincter function. Scand J Gastroenterol 26:563–571, 1991PubMedGoogle Scholar
  26. 26.
    Kramer P: Effect of antidiarrheal and antimotility drugs on ileal excreta. Am J Dig Dis 22:327–332, 1977PubMedGoogle Scholar
  27. 27.
    Körner MM: Differential effects of loperamide on gut motility. Gastroenterology 82:1255, 1982Google Scholar
  28. 28.
    O'Connell PR, Pemberton JH, Brown ML, Kelly KA: Determinants of stool frequency after ileal pouch-anal anstomosis. Am J Surg 153:157–164, 1987PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • T. Hallgren
    • 1
  • S. Fasth
    • 1
  • D. S. Delbro
    • 1
  • S. Nordgren
    • 1
  • T. Öresland
    • 1
  • L. Hultén
    • 1
  1. 1.From the Department of SurgeryUniversity of GöteborgGöteborgSweden

Personalised recommendations