Document Detail

The physical properties of rectal contents have effects on anorectal continence: insights from a study into the cause of fecal spotting on orlistat.
MedLine Citation:
PMID:  15657667     Owner:  NLM     Status:  MEDLINE    
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Mark Fox; Werner Schwizer; Dieter Menne; Bernadette Stutz; Michael Fried; Miriam Thumshirn
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  47     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2005-01-19     Completed Date:  2005-02-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2147-56     Citation Subset:  IM    
Department of Gastroenterology and Hepatology, University Hospital of Zürich, Zürich, Switzerland.
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MeSH Terms
Administration, Oral
Anal Canal / physiopathology
Analysis of Variance
Anti-Obesity Agents / administration & dosage,  adverse effects*,  metabolism
Cross-Over Studies
Fatty Acids, Nonesterified / adverse effects,  analysis
Fecal Incontinence / chemically induced*,  metabolism,  physiopathology
Feces* / chemistry
Gastrointestinal Contents / chemistry
Intestinal Absorption
Lactones / administration & dosage,  adverse effects*,  metabolism
Linear Models
Metabolic Clearance Rate
Plant Oils
Rectum / physiopathology
Reg. No./Substance:
0/Anti-Obesity Agents; 0/Fatty Acids, Nonesterified; 0/Lactones; 0/Plant Oils; 96829-58-2/orlistat

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