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Loperamide improves anal sphincter function and continence after restorative proctocolectomy

T Hallgren¹, S Fasth, D S Delbro

¹Department of Surgery, University of Göteborg, Sweden.

Digestive Diseases and Sciences

|December 1, 1994

Summary

Loperamide treatment improved clinical outcomes for patients after restorative proctocolectomy by increasing resting anal pressure. This led to reduced bowel frequency and better nighttime continence, with less soiling.

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Area of Science:

Gastroenterology and Surgery
Pharmacology

Background:

Restorative proctocolectomy can lead to altered bowel function and incontinence.
Loperamide is an antimotility agent that may improve anal sphincter function.

Purpose of the Study:

To investigate the physiological and clinical effects of loperamide versus placebo in patients post-restorative proctocolectomy.
To assess loperamide's impact on anal pressure, pouch function, and clinical outcomes.

Main Methods:

A randomized, double-blind, crossover study design.
Inclusion of patients with endoanal mucosectomy and handsewn ileal pouch-anal anastomosis (n=16).
Inclusion of patients with abdominal proctocolectomy and stapled pouch-anal anastomosis (n=14).

Main Results:

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Loperamide significantly increased resting anal pressure by approximately 20% (P < 0.05) in both patient groups.
Squeeze pressure, pouch volume, contractility, sensory thresholds, and recto/pouch-anal inhibitory reflex were not affected.
Clinical function improved, with reduced bowel frequency and enhanced nighttime continence (P < 0.05).

Conclusions:

Loperamide effectively improves resting anal pressure and clinical function in patients following restorative proctocolectomy.
The drug reduces bowel frequency and improves continence, decreasing the need for protective pads.