Abstract
Symptom scores, stool data, and the transit of a standard, solid meal were measured in 28 patients with irritable bowel syndrome (IBS) during baseline conditions and after five weeks of treatment with placebo and loperamide, given as a flexible dosage regime in the form of a double-blind, cross-over trial. All patients had undergone a comprehensive series of diagnostic investigations and had failed to respond to dietary supplementation with coarse wheat bran (10–30 g daily). Loperamide treatment accelerated gastric emptying, compared with placebo (1.2±0.1 vs 1.5±0.1 hr; P<0.001) and delayed both small bowel (6.2±0.3 vs 4.3±0.3 hr P<0.001) and whole gut transit (56±5 vs 42±4 hr; P<0.01). Eighteen patients said they felt better taking loperamide compared with placebo and, at follow up, 15 of these patients remained satisfied with the effects of the drug. Most symptoms improved significantly on placebo compared with the baseline period, but three of these [diarrhea (P<0.01), urgency (P<0.01) and borborygmi (P<0.05)] showed a further significant improvement on loperamide. Improvement in diarrhea was not associated with any change in stool weight but was associated with reductions in stool frequency (P<0.001), passage of unformed stools (P<0.01), and incidence of urgency (P<0.001). Urgency was the only symptom that was significantly more common in the success group, compared with the group who did not feel better on loperamide.
Similar content being viewed by others
References
Snape WJ, Carlson GM, Matarazzo SA, Cohen S: Evidence that abnormal myoelectric activity produces colonic motor dysfunction in the irritable bowel syndrome. Gastroenterology 72:383–387, 1977
Connell AM: The motility of the pelvic colon. II. Paradoxical motility in diarrhea and constipation. Gut 3:342–348, 1962
Whitehead WE, Engel BT, Schuster MM: Irritable bowel syndrome: Physiological and psychological differences between diarrhea-predominant and constipation-predominant patients. Dig Dis Sci 25:404–413, 1980
Whorwell PJ, Clouter C, Smith CL: Oseophageal motility in the irritable bowel syndrome. Br Med J 1:1101–1103, 1981
Horowitz L, Farrar JT: Intraluminal small intestinal pressures in normal patients and in patients with functional gastrointestinal disorders. Gastroenterology 42:455–464, 1962
Corbett CL, Thomas S, Read NW, Hobson N, Bergman I, Holdsworth CD: Electrochemical detector for breath hydrogen determination: Measurement of small bowel transit time in normal subjects and patients with the irritable bowel syndrome. Gut 22:836–840, 1981
Cann PA, Read NW, Holdsworth CD: The irritable bowel syndrome (IBS): Relationship of disorders in the transit of a single solid meal to symptom patterns. Gut 24:405–411, 1983
Remington MM, Brown ML, Robertson JS, Fleming CR, Carlson G, Whatley J, Thomford G, Malagelada JR: Transit of solid and liquid components of a meal in the short bowel syndrome quantified by total gut scintiscanning: Effects of loperamide. Gastroenterology 80:A1260, 1981
Heel RC, Brogden RN, Speight TM, Avery GS: Loperamide: A review of its pharmacological properties and therapeutic efficacy in diarrhea. Drugs 15:33–52, 1978
Verhaegen H, De Cree J, Schuermans U: Loperamide, a novel type of anti-diarrhea agent. Arzneim Forsch 24:1653–1660, 1974
Amery W, Duyek F, Polak J: A multicentre double-blind study in acute diarrhoea, comparing loperamide with two common anti-diarrhoeal agents and a placebo. Current Ther Res 17:263–270, 1975
Palmer KR, Corbett CL, Holdsworth CD: Double-blind crossover study, comparing loperamide, codeine phosphate and diphenoxylate in the treatment of chronic diarrhea. Gastroenterology 79:1271–1275, 1980
Almy PT, Fielding JF: Chapter 8.In The GI Tract in Stress and Psychosocial Disorder. Clinics in Gastroenterology, Vol. 6. London, WB Saunders, 1977, No. 3
Chaudhury NA, Truelove SC: The irritable colon syndrome. Q J Med 31:307–322, 1962
Read NW, Miles CA, Fisher D, Holgate AM, Kime ND, Mitchell MA, Reeve AM, Roche TB, Walker M: Transit of a meal through the stomach, small intestine and colon in normal subjects and its role in the pathogenesis of diarrhoea. Gastroenterology 79:1276–1282, 1980
Ostick DG, Green G, Howe K: Simple clinical method of measuring gastric emptying of solid meals. Gut 17:189–191, 1976
Holgate AM, Read NW: Relationship between small bowel transit time and absorption of a solid meal: Influence of metoclopramide, magnesium sulfate, and lactulose. Dig Dis Sci 28:812–819, 1983
Bond JH, Levitt MD: Investigation of small bowel transit time in man utilizing pulmonary hydrogen (H2O) measurements. J Lab Clin Med 85:546–559, 1974
Bergman I, Coleman JE, Evans D: A simple gas chromatograph with an electrochemical detector for the measurement of hydrogen and carbon monoxide in the parts per million range, applied to exhaled air. Chromatographia 8:581–583, 1975
Cammack J, Read NW, Cann PA, Greenwood B, Holgate AM: Effect of prolonged exercise in the passage of a solid meal through the stomach and small intestine. Gut 23:957–961, 1982
Hinton JM, Lennard Jones JE, Young AC: A new method for studying gut transit times using radio-opaque markers. Gut 10:842–847, 1969
Goulston K: Drug usage in the irritable colon syndrome. Med J Aust 1:1126–1131, 1972
Fielding JF: The necessity of concurrent high dietary fibre intake when testing for drug efficacy in the irritable bowel syndrome. Gastroenterology 82(5):1056A, 1982
Cann PA, Read NW, Holdsworth CD: What is the benefit of coarse wheat bran in patients with the irritable bowel syndrome? Gut 25:168–173, 1984
Mainquet P, Fiasse R: Double-blind placebo-controlled study of loperamide in chronic diarrhoea casued by ileocolic disease or resection. Gut 18:575–579, 1977
Karim SMM, Adaikan PG: The effect of loperamide on prostaglandin-induced diarrhoea in rat and man. Prostaglandins 13:321–331, 1977
Sandhu BK, Tripp JH, Candy DCA, Harries JT: Loperamide: Studies on its mechanism of action. Gut 22:658–662, 1981
McKay JS, Linaker BD, Turnberg LA: The influence of opiates on ion transport across rabbit ileal mucosa. Gastroenterology 80:279–284, 1981
Read MG, 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
Author information
Authors and Affiliations
Additional information
The study was supported by a project grant from the Medical Research Council. Dr. Cann was funded by Janssen Pharmaceuticals (UK), Marlow, Buckinghamshire.
Rights and permissions
About this article
Cite this article
Cann, P.A., Read, N.W., Holdsworth, C.D. et al. Role of loperamide and placebo in management of irritable bowel syndrome (IBS). Digest Dis Sci 29, 239–247 (1984). https://doi.org/10.1007/BF01296258
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296258