EFFECTS OF LOPERAMIDE ON ILEOANAL POUCH FUNCTION

Background Opioid analogues are used to manage increased bowel frequen cy in patients with an ileoanal reservoir. The aim of the study was to determine the clinical efficacy of loperamide in patients with an ile oanal reservoir and to assess its effect on pouch motility, Methods Fo urteen patients with a pouch who had normal pouch emptying and anal fu nction were studied. Ambulatory pouch and anal motility, and stool wei ghts, were recorded for 24 h while taking no medication and for 24 h w hile receiving 8 mg loperamide. In a second analysis, patients were di vided on the basis of bowel frequency into those with 4 or fewer motio ns (good function; n = 6) and those with more than 6 per day (poor fun ction; n = 8), to determine any differential effects of loperamide. Re sults Loperamide decreased median bowel frequency (no loperamide 5.5 v ersus loperamide 4.0, P = 0.03) and 24-h stool weight (610 g versus 41 3 g, P = 0.03) but not individual stool weights. Patients with poor fu nction had both higher bowel frequency (8 0 versus 3.5 per 24 h, P = 0 .004) and higher stool weight (728 g versus 430 g, P = 0.05) with no t reatment than those with good function. High-amplitude pouch pressure waves were greater in number before defaecation in patients with poor function and did not decrease with loperamide, in contrast to patients with good function. Pouch baseline pressure decreased after defaecati on to a similar extent in both groups and was not affected by loperami de. Conclusion Loperamide 8 mg per day reduces bowel frequency by redu cing total stool weight, not individual stool weights. In patients wit h good function it also affects pouch motility. High bowel frequency i s associated with increased pouch high-pressure waves.