Treatment of Chronic Diarrhoea: Loperamide versus Ispaghula Husk and Calcium

Abstract

Twenty-five patients with chronic diarrhoea were included in an open, randomized crossover trial comparing the effect of loperamide with ispaghula and calcium. Nineteen patients completed both treatments. Before treatment the median number of daily stools was 7 (range, 4-13), stool consistency was loose in all, and urgency was present in 16 out of 19 patients. Both treatments halved stool frequency, but with regard to urgency and stool consistency ispaghula and calcium was significantly better. A combination of ispaghula and calcium seems to be a cheap and effective alternative to conventional treatment of chronic diarrhoea. Moreover, side effects were minimized.

Pharmacological Basis for the Medicinal Use of Psyllium Husk (Ispaghula) in Constipation and Diarrhea

“…However, to the best of our knowledge, no details are known about the possible underlying mechanism(s), responsible for its medicinal use in constipation, except a preliminary report [25], and a general understanding that its effectiveness in constipation is attributed to its high fiber and mucilaginous content. Similarly, there are some reports validating the medicinal use of psyllium husk in the treatment of diarrhea [26][27][28][29], but no evidence is available explaining the mode of action of its antidiarrheal effect.…”

Characterization of Psyllium (Plantago ovata) Polysaccharide and Its Uses

“…Only 20 % of individuals with slow transit responded to psyllium. A slightly greater percentage (37 %) of those with disorders of defecation -including rectocele, internal prolapse, anismus, and rectal hyposensitivity -found improvement (Alternative Medicine Review 2002; Voderholzer et al 1997;Kumar et al 1987;Qvitzau et al 1988). …”

The non-surgical treatment of adult patients with short bowel syndrome

“…However, a pectin supplement did not increase macronutrient or energy absorption (1768 vs. 1477 kcal/day, p = 0.15); faecal wet weight (1582 vs 1689 g/day, p = 1.00) and urine production (1615 vs. 1610 ml/d, p = 1.00) remained constant [22]. SBS patients with a colon in continuity report beneficial effects of ispaghula husk and calcium on stool viscosity and consistency, which may ameliorate the sensation of urgency [23]. Some patients with an end ostomy will report benefit from the use of fiber supplements as they help to gelatinize the ostomy effluent.…”