orlistat and Fecal-Incontinence

Obesity in adolescents presents many challenges for the patient, family, and physician. The myriad problems involving the GI tract will be managed more effectively when the treating physician has an understanding of the presentations, pathophysiology, appropriate laboratory evaluation, and approaches to treatment for these complications. In addition to being familiar with the pharmacotherapeutic options available, having an approach to behavioral change, such as MI, can be an extremely useful tool.

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Anti-Obesity Agents; Constipation; Contraceptives, Oral, Combined; Diabetes Mellitus, Type 2; Digestive System Diseases; Fecal Incontinence; Gallstones; Gastroesophageal Reflux; Humans; Hypoglycemic Agents; Lactones; Metformin; Non-alcoholic Fatty Liver Disease; Orlistat; Pancreatitis; Pediatric Obesity

Continence problems during treatment with orlistat (a lipase inhibitor) are caused when susceptible patients are exposed to increased volumes of loose, fatty stool.. To investigate the dose-response effects of loperamide on continence and anorectal function in subjects susceptible to continence problems on orlistat.. Ten obese subjects enterred a randomized controlled, double-blind study of loperamide at placebo, 2, 4, and 6 mg/day in a factorial design. Continence problems during orlistat treatment were self-assessed by patient diary. Anorectal function and continence were assessed by barostat, manometry, and retention testing.. Loperamide increased stool consistency with dose (p = 0.07) and this effect reduced continence problems during orlistat treatment (p < 0.05). A bell-shaped dose-response relationship was present with anal sphincter function (p < 0.01) and anorectal sensitivity (p < 0.01).. Loperamide has beneficial effects on stool consistency and continence in obese subjects taking orlistat. The effect on stool consistency appeared more important than effects on anorectal function.

Topics: Adult; Anal Canal; Anti-Obesity Agents; Antidiarrheals; Double-Blind Method; Fecal Incontinence; Female; Humans; Lactones; Loperamide; Male; Middle Aged; Obesity; Orlistat; Placebos; Rectum

The intermittent loss of oil or liquid faeces ('spotting') is an adverse effect that occurs in obese patients during treatment with the lipase inhibitor orlistat; the pathophysiology is unknown.. To investigate the effects of orlistat on anorectal sensorimotor function and continence.. Obese subjects susceptible to spotting were identified by an unblind trial of orlistat. Obese spotters (n = 15) and non-spotters (n = 16) completed a randomized, double-blind, cross-over trial of orlistat and placebo. Anorectal function was assessed by rectal barostat and anal manometry, together with a novel stool substitute retention test, a quantitative measurement of faecal continence.. Orlistat increased stool volume and raised faecal fat and water. Treatment had no effect on anorectal motor function, but rectal sensation was reduced; on retention testing, the volume retained was increased. Subjects susceptible to spotting had lower rectal compliance, heightened rectal sensitivity and weaker resting sphincter pressure than non-spotters. On retention testing, gross continence was maintained; however, spotters lost small volumes of rectal contents during rectal filling.. Treatment with orlistat has no direct adverse effects on anorectal function or continence. Spotting occurs during treatment with orlistat when patients with sub-clinical anorectal dysfunction are exposed to increased stool volume and altered stool composition.

Topics: Adult; Anti-Obesity Agents; Cross-Over Studies; Double-Blind Method; Fecal Incontinence; Feces; Female; Humans; Lactones; Male; Manometry; Medical Records; Middle Aged; Obesity; Orlistat; Prospective Studies; Reproducibility of Results

To investigate the efficacy and tolerability of orlistat in obese adolescents, a prospective, open-label, randomised, controlled pilot trial was performed. A total of 22 adolescents with exogeneous obesity were started on orlistat (120 mg tid) and a daily multivitamin preparation in addition to conventional treatment which included nutritional and lifestyle modification programmes. The control group consisted of 20 obese adolescents who had similar duration of follow-up under conventional treatment alone. Of the 22 patients, 7 dropped out within the 1st month of the trial due to side-effects attributable to orlistat. The remaining 15 patients on orlistat were followed for 5-15 months (average duration of treatment 11.7 +/- 3.7 months). The control group was similar in age, sex, and duration of follow-up (10.2 +/- 3.7 months, range 6-17 months) to the orlistat group. Compared to initial body weight, patients in the orlistat group lost -6.27 +/- 5.4 kg, whereas those in the control group gained 4.16 +/- 6.45 kg (P < 0.001) during the study period. Patients in the orlistat group lost -7.65% +/- 6.5% of their initial body weight, whereas, those of the control group gained 5.7% +/- 8.3% (P < 0.001). The body mass index decreased in the orlistat group by -4.09 +/- 2.9 kg/m2 while it increased by + 0.11 +/- 2.49 kg/m2 in the control group (P < 0.001). Mild gastrointestinal complaints (frequent stools) were experienced by all patients in the orlistat group.. Orlistat could be a useful adjunct in the treatment of severe obesity in adolescents; however, gastrointestinal side-effects limit its usefulness in almost one in three adolescents.

Topics: Adolescent; Anti-Obesity Agents; Body Mass Index; Caloric Restriction; Child; Combined Modality Therapy; Exercise; Fecal Incontinence; Female; Humans; Lactones; Life Style; Lipase; Male; Obesity; Orlistat; Pilot Projects; Prospective Studies; Treatment Outcome; Vitamins

The intermittent loss of oil or stool ("spotting") is an adverse effect that occurs in patients taking orlistat; the pathophysiology is unknown. This study was designed to investigate the local effects of orlistat, free fatty acids, and the effects of the physical properties of rectal contents on anorectal function and continence.. Anorectal physiology and continence function were assessed in ten healthy patients after the application of four test enemas: 1) high-viscosity stool substitute, 2) stool substitute with free fatty acid, 3) low-viscosity oil with placebo, 4) oil with orlistat. Rectal function and capacity were assessed by barostat techniques. Anal resting pressure, squeeze pressure, and squeeze duration were assessed by manometry. A retention test was performed using the same enemas as a quantitative assessment of continence.. Orlistat and free fatty acid had no adverse effects on anorectal function or continence. For each enema, the maximum volume retained correlated with rectal capacity (r = 0.85; P < 0.01). Continence during rectal filling was better maintained for high-viscosity stool substitute than low-viscosity oil enemas (P < 0.03). Patients able to maintain effective squeeze pressure retained more of the low-viscosity enemas than those with short squeeze duration (P < 0.01); in contrast, the volume retained of high-viscosity enemas was unaffected by anal sphincter function.. The physical properties of rectal contents, rectal capacity, and voluntary anal sphincter function have effects on continence function in healthy patients. The occurrence of spotting may depend on both intrinsic anorectal function and the effects of orlistat on the volume and physical properties of stool.

Topics: Administration, Oral; Adult; Anal Canal; Analysis of Variance; Anti-Obesity Agents; Causality; Cross-Over Studies; Defecation; Enema; Fatty Acids, Nonesterified; Fecal Incontinence; Feces; Female; Gastrointestinal Contents; Humans; Intestinal Absorption; Lactones; Linear Models; Male; Manometry; Metabolic Clearance Rate; Orlistat; Plant Oils; Rectum; Sensation; Viscosity

Topics: Absorption; Anti-Obesity Agents; Dietary Fats; Drug Industry; Fecal Incontinence; Humans; Lactones; Orlistat