effects of loperamide on pancreaticobiliary functions are Loperamide, a peripherally acting opiate receptor agonist poorly investigated. Inhibition of gallbladder emptying or with antidiarrheal action, inhibits ileal and colonic motor pancreatic enzyme secretion by loperamide may have imfunction. It was determined whether loperamide also affects portant clinical implications because stasis of bile is a major gallbladder emptying and pancreatic enzyme secretion in hufactor contributing to the formation of gallstones 6-10 and bemans. Plasma cholecystokinin (radioimmunoassay), gallbladcause impairment of pancreatic enzyme secretion may induce der volume (ultrasonography), and intraduodenal bilirubin or aggravate maldigestion. 11-13 and amylase output (spot sampling) were measured at regularThe aim of this study, therefore, was to determine the intervals before and during intraduodenal perfusion of an effect of loperamide on basal and meal-stimulated gallbladder amino acid meal in 8 healthy subjects: once without and once motility and pancreatic enzyme secretion in healthy volunwith pretreatment of 8 mg loperamide, ingested 13 and 4 teers. Gallbladder emptying and pancreatic enzyme secretion hours before the start of the meal. Loperamide decreased were studied in response to an intraduodenal amino acid basal amylase output from 3.2 { 0.5 to 1.0 { 0.5 kU/h meal to circumvent possible influences of loperamide on gas-(P õ .005) and abolished basal bilirubin output (21 { 5 vs.tric emptying or on the digestion of nutrients. 14 0 { 0 mmol/h; P õ .005) into the duodenum. Loperamide increased basal gallbladder volume from 28 { 4 to 39 { 4 PATIENTS AND METHODS mL (P õ .0001) but was without effect on basal plasma cholecystokinin (2.7 { 0.3 vs. 3.0 { 0.3 pmol/L). During Subjects. Eight healthy volunteers (3 women and 5 men; age the amino acid meal, pretreatment with loperamide inhibited range, 19-27 years) participated in the studies. None of the volunamylase output from 5.1 { 0.8 to 1.6 { 0.4 kU/h (P õ .001), teers was taking any medication or had a history of gastrointestinal bilirubin output from 39 { 6 to 18 { 6 mmol/h (P õ .0005) symptoms or surgery. The study protocol was approved by the and gallbladder contraction from 47% { 3% to 26% { 6% ethical committee of the University Hospital Nijmegen, and all sub-(P õ .05), whereas loperamide enhanced amino acid-stimu-jects gave their written informed consent before entering the study.