Effect of loperamide on fecal output and composition in well-established ileostomy and ileorectal anastomosis

Abstract

The quantitative effects of the antidiarrheal drug loperamide (Imodium®) on several parameters of fecal composition and output were assessed in 7 patients with an ileorectal anastomosis and 7 patients with an ileostomy. Loperamide (two 2 mg capsules tid) or placebo were administered double-blind in two randomly assigned successive 7-day periods. Loperamide significantly decreased the daily volume, wet weight, water content, and fecal excretion rate and significantly increased the bulk density and viscosity of the fecal collections. Electrolyte loss was significantly diminished with loperamide: Daily sodium and chloride outputs significantly decreased; daily calcium, phosphate and potassium outputs slightly decreased. Sodium concentration significantly decreased, while potassium and calcium concentrations significantly increased, phosphate concentrations slightly increased, and chloride concentrations slightly decreased. The sodium/potassium ratio was significantly reduced. No effect on fecal dry weight or on lipid or bile acid outputs was observed. Differences in fecal composition between patients with an ileorectal anastomosis and those with an ileostomy were identified. Potassium concentration and output were significantly higher, and the sodium/potassium ratio was significantly lower in patients with an ileorectal anastomosis. This group also showed a tendency to slightly lower fecal volume, wet weight, water content, fecal excretion rate, sodium concentration, and output. A patient per patient evaluation of clinical responsiveness to loperamide was made by comparing several fecal variables before and after loperamide treatment. The therapeutic efficacy of loperamide was comparable in both patient groups. Results were rated “excellent” in 3 patients, “good” in 7, “questionable” in 3 and “poor” in 1. No adverse effects attributable to loperamide were observed. All patients reported feeling better during loperamide treatment and preferred the active drug period to the placebo period.