We have investigated the fasting and postprandial patterns of gastrointestinal pressure activity in a group of patients with extensive (>100 cm) resections of the distal small bowel. Each short bowel patient was studied on 2 consecutive days with random single blind administration of either loperamide (6 mg at 5 h and at 30 min before the meal) or placebo, and 20 healthy controls were studied on single days (13 basal fasting, 7 placebo). During fasting, the duration of the interdigestive motor complex was significantly shorter in patients with short bowel syndrome (71.1 ± 15.6 min vs. 109 ± 7.8 min for controls, p < 0.03); hence, the frequency of complexes was increased. The duration of phase 2 was strikingly shorter in patients (18.7 ± 7.0 min vs. 52.9 ± 8.5 min for controls, p < 0.03). Gastric emptying and postprandial motor activity were identical in patients and controls. During fasting, loperamide prolonged phase 3 (7.6 ± 2.2 min vs. 4.3 ± 1.1 min for placebo, p < 0.03). Postprandially, loperamide shortened the time from meal ingestion to the first phase 3 by 50% (p < 0.003), and increased motility index and frequency of contraction in the gut (p < 0.01). Thus, gut motor activity in the short bowel syndrome is characterized by more frequent interdigestive motor complexes, marked reduction in phase 2 activity, and a normal feeding pattern. Loperamide therapy increases feeding activity while at the same time shortening its duration.
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