Brydon, G.; Ganguly, R.; Ghosh, S.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA9
Academic Journal
Introduction: Hydroxypropylcellulose (HPC) is a food additive found in soups and ice creams where it acts as a thickener and emulsifier. Watery diarrhoea caused by bile acid malabsorption may be helped by HPC, which binds bile acids and may thereby reduce the laxative effect of bile acids on the colon. Patients and Methods: Five patients (two men, three women) with idiopathic bile acid malabsorption (IBAM) and five patients (two men, three women) with quiescent Crohn's disease with ileal resection were recruited into the study. All suffered from watery diarrhoea and were intolerant of cholestyramine. All underwent a 1 week baseline study period (week 0) when they kept a diary of their bowel habits and also discontinued Ioperamide or other anti-diarrhoeals. All patients then had HPC in water for 6 weeks (1 gm/day for week 1 to week 4 and 1.5 gm/day for week 5 to week 6). A diary of bowel habits was maintained daily throughout the study. The study was approved by the Lothian Ethics in Research Medicine and Oncology Subcommittee. Results: HPC forms a viscous solution in water. All patients tolerated the intake of HPC and no untoward side effects were noted. The mean stool frequency per day decreased from 5.2 (SD 2.1) during week 0 to a mean frequency of 2.9 (SD 1.5) per day during week 6. This was a significant reduction in bowel frequency (p = 0.001; paired t test) compared to bowel frequency in the week prior to HPC administration. Nine out of 10 patients also reported a subjective improvement in their stool consistency, urgency, and incontinence. Conclusion: In this proof of concept study, HPC resulted in a significant reduction in stool frequency in patients with watery diarrhoea due to bile acid malabsorption. It may provide a safe treatment of this condition as an alternative to cholestyramine and it does not bind to concurrently administered medications. Randomised trials are warranted to further establish the role of HPC in watery diarrhoea caused by bile...


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