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

Alimentary Pharmacology & Therapeutics
E PlacidiP A Gowland

Abstract

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. 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. 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. LOP and LOP + SIM significantly accelerated gastric emptying (P < 0.03) and reduced SBWC during the late phase (135-270 min after mannitol ingestion), P < 0.009, while delaying arrival of fluid in the ascending colon (AC). The relaxation time T2 of the contents of the AC was r...Continue Reading

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Citations

Oct 18, 2013·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·S E PritchardR C Spiller
Jul 26, 2014·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·L MarcianiR C Spiller
Apr 26, 2017·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·S E PritchardC L Hoad
Nov 20, 2013·JPEN. Journal of Parenteral and Enteral Nutrition·Darlene G KellyMarion F Winkler
Jun 27, 2017·Molecular Pharmaceutics·Kathryn MurrayLuca Marciani
Aug 1, 2018·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·G MajorR Spiller
Jan 5, 2019·Journal of Magnetic Resonance Imaging : JMRI·Esben B MarkAsbjørn M Drewes
May 29, 2019·Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society·Robin Spiller, Caroline Hoad
Nov 18, 2017·The Oncologist·Manuela Schmidinger, Romano Danesi
Apr 3, 2019·Pharmaceutics·Sarah Sulaiman, Luca Marciani
Aug 15, 2021·Advanced Drug Delivery Reviews·Connor O'FarrellHannah Batchelor
Sep 1, 2013·EJC Supplements : EJC : Official Journal of EORTC, European Organization for Research and Treatment of Cancer ... [et Al.]·Manuela Schmidinger

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