The effects of loperamide, or loperamide plus simethicone, on the distribution of gut water as assessed by MRI in a mannitol model of secretory diarrhoea

Summary Background Loperamide (LOP) is an anti‐diarrhoeal agent which is thought to act largely by slowing transit with an uncertain effect on the fluid content of the small and large bowel in humans. Adding simethicone (SIM) to LOP improves its efficacy, but the mechanism of interaction is unclear....

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Bibliographic Details
Published in:Alimentary pharmacology & therapeutics 2012-07, Vol.36 (1), p.64-73
Main Authors: Placidi, E., Marciani, L., Hoad, C. L., Napolitano, A., Garsed, K. C., Pritchard, S. E., Cox, E. F., Costigan, C., Spiller, R. C., Gowland, P. A.
Format: Article
Language:English
Subjects:
Adult
Antidiarrheals - therapeutic use
Antifoaming Agents - therapeutic use
Biological and medical sciences
Body Water - metabolism
Cross-Over Studies
Diarrhea - chemically induced
Diarrhea - drug therapy
Diarrhea - metabolism
Digestive system
Double-Blind Method
Drug Therapy, Combination
Female
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal Motility - physiology
Humans
Intestinal Absorption - physiology
Intestine, Small - metabolism
Loperamide - therapeutic use
Magnetic Resonance Imaging
Male
Mannitol - adverse effects
Medical sciences
Middle Aged
Other diseases. Semiology
Pharmacology. Drug treatments
Simethicone - therapeutic use
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Young Adult
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Summary:Summary Background Loperamide (LOP) is an anti‐diarrhoeal agent which is thought to act largely by slowing transit with an uncertain effect on the fluid content of the small and large bowel in humans. Adding simethicone (SIM) to LOP improves its efficacy, but the mechanism of interaction is unclear. Novel MRI techniques to assess small bowel water content (SBWC) have shown that mannitol solutions markedly increase SBWC and can be used as a model of diarrhoea. Aim We aimed to use quantitative MRI techniques to compare the actions in the gut of LOP and LOP + SIM in a model of secretory diarrhoea using mannitol. Methods A total of 18 healthy volunteers ingested capsules containing placebo (PLA) or 12 mg LOP or 12 mg LOP + 125 mg SIM. After 100 min they were given a drink containing 5% mannitol in 350 mL of water. They underwent baseline fasting and postprandial serial MRI scans at 45 min intervals for 4.5 h after ingesting the drink. A range of MRI sequences was acquired to image the gut. Results LOP and LOP + SIM significantly accelerated gastric emptying (P 
ISSN:0269-2813
1365-2036
DOI:10.1111/j.1365-2036.2012.05127.x