Antidiarrhoeal therapy for short bowel syndrome

To reduce small bowel and colonic motility in adults with short bowel syndrome, use an antidiarrhoeal drugNightingale, 2006:

The initial dose depends on the severity of symptoms. Occasionally, high doses of loperamide (up to 24 mg per dose) may be required because passage through the enterohepatic circulation is disrupted in patients with a short bowel. In some patients, combination therapy with loperamide plus codeine appears to have a synergistic effect.

In patients who have had the terminal ileum resected but have an intact colon, the disruption of enterohepatic circulation can lead to malabsorption of bile salts, which may cause a secretory diarrhoea in the colon. Colestyramine can help to relieve bile salt diarrhoea by binding the bile salts. However, if more than 100 cm of ileum has been removed, colestyramine can increase diarrhoea by exacerbating bile salt loss, leading to steatorrhoea. Therefore, it is important to know how much ileum has been resected before starting colestyramine, and to evaluate the clinical response during therapy. If appropriate, for adults, use:

All other drugs should be taken at least 1 hour before, or 4 to 6 hours after colestyramine.