This protocol addresses severe malabsorption arising from intestinal insufficiency or intestinal failure, where diarrhoea and ongoing gastrointestinal fluid losses compound the underlying absorptive deficit. Managing fluid losses is a central priority in this population.
In intestinal insufficiency and intestinal failure, diarrhoea drives significant gastrointestinal fluid losses that worsen the patient's clinical state. Antimotility agents are a recognised intervention in this context, used specifically to reduce fluid losses in severe malabsorption.
The protocol centres on an antimotility agent. One specific agent is preferred over available alternatives on the basis of its tolerability profile. The complete regimen — including the preferred agent, how it is initiated, and the criteria-driven stepwise escalation to maximum benefit — is set out in the full protocol.
The primary clinical targets are a reduction in gastrointestinal fluid losses and a decrease in faecal wet weight output.
Antimotility drugs (e.g., loperamide, diphenoxylate, codeine, opium tincture, octreotide) may be useful in patients with severe malabsorption such as intestinal insufficiency, to reduce gastrointestinal fluid losses.
Loperamide is preferable to diphenoxylate because of the lack of central nervous system effects.
The dose of the anti-motility agents should be adjusted and escalated in a stepwise manner until maximum benefit is observed, adverse events occur, or the recommended maximum dose is reached.
Loperamide inhibits the peristaltic activity of the small intestine and prolongs intestinal transit time, thus increasing the time for water and sodium absorption.
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