{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:56:04Z","timestamp":1788850564427,"version":"build-2803163510"},"reference-count":38,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1988,3]]},"abstract":"<jats:p>Patients with chronic severe diarrhoea after truncal vagotomy and pyloroplasty are often difficult to treat using conventional antidiarrhoeal drugs and remain severely disabled. We examined the effect of two drugs, codeine phosphate and loperamide, on upper intestinal transit and carbohydrate absorption, measured non-invasively by serial exhaled breath hydrogen monitoring, in patients with postvagotomy diarrhoea who had previously failed to gain relief from drug therapy. Orocaecal transit was consistently faster in these patients than a group of controls and was associated with malabsorption of glucose. Codeine phosphate 60 mg significantly delayed transit in patients and controls and was associated with a reduction in glucose malabsorption and improvement in symptoms. Loperamide also delayed transit and improved symptoms, but the doses required for this effect (12-24 mg) were higher than usually considered necessary in secretory diarrhoea. These studies indicate that rapid intestinal nutrient transit and associated malabsorption is a factor in the development of diarrhoea postvagotomy and that symptomatic relief can be achieved in most patients by more rational use of existing drugs.<\/jats:p>","DOI":"10.1136\/gut.29.3.312","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"312-318","source":"Crossref","is-referenced-by-count":50,"title":["Effect of codeine and loperamide on upper intestinal transit and absorption in normal subjects and patients with postvagotomy diarrhoea."],"prefix":"10.1136","volume":"29","author":[{"given":"J D","family":"O'Brien","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D G","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"McIntyre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W R","family":"Burnham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1988,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1136\/bmj.3.5830.788","article-title":"Vagotomy without diarrhoea","volume":"3","author":"Johnston, D.; Humphrey, C.S.; Walker, B.E.; Pulvestaft, C.N.; Goligher, J.C.","year":"1972","unstructured":"Johnston D, Humphrey CS, Walker BE, Pulvestaft CN, Goligher JC. Vagotomy without diarrhoea. Br Med J 1972; 3: 788-90.","journal-title":"Br Med J"},{"key":"ref_2","first-page":"263","article-title":"Which vagotomy?","volume-title":"Topics in gastroenterology 5","author":"Kennedy, T.","year":"1977","unstructured":"Kennedy T. Which vagotomy? In: Truelove SC, Lee E, eds. Topics in gastroenterology 5. London: Blackwell 1977: 263-84."},{"key":"ref_3","first-page":"851","article-title":"Post vagotomy diarrhoea put into perspective Lancet","volume":"i:","author":"Raimes, S.A.; Smirniotis, V.; Wheldon, E.J.; Venables, C.W.; Johnston, I.D.A.","year":"1986","unstructured":"Raimes SA, Smirniotis V, Wheldon EJ, Venables CW, Johnston IDA. Post vagotomy diarrhoea put into perspective Lancet 1986; i: 851-3."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1002\/bjs.1800571012","article-title":"Gastric incontinence and post vagotomy diarrhoea","volume":"57","author":"McKelvey, S.T.D.","year":"1970","unstructured":"McKelvey STD. Gastric incontinence and post vagotomy diarrhoea. Br J Surg 1970; 57: 741-7.","journal-title":"Br J Surg"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1002\/bjs.1800610704","article-title":"The role of bile acids in the pathogenesis of post-vagotomy diarrhoea","volume":"61","author":"Allan, J.G.; Gerskowitch, V.P.; Russell, R.I.","year":"1974","unstructured":"Allan JG, Gerskowitch VP, Russell RI. The role of bile acids in the pathogenesis of post-vagotomy diarrhoea. Br J Surg 1974; 61: 516-8.","journal-title":"Br J Surg"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1001\/jama.1951.02920290021005","article-title":"Appraisal of vagotomy for peptic ulcer after seven years","volume":"145","author":"Dragstedt, L.R.; Woodward, E.R.","year":"1951","unstructured":"Dragstedt LR, Woodward ER. Appraisal of vagotomy for peptic ulcer after seven years. JAm Med Assoc 1951; 145: 795-802.","journal-title":"JAm Med Assoc"},{"key":"ref_7","first-page":"168","article-title":"IgA deficiency and severe post vagotomy diarrhoea","volume":"i:","author":"McLoughlin, G.A.; Bradley, J.; Chapman, D.M.; Temple, J.G.; Hede, J.E.; McFarland, J.","year":"1976","unstructured":"McLoughlin GA, Bradley J, Chapman DM, Temple JG, Hede JE, McFarland J. IgA deficiency and severe post vagotomy diarrhoea. Lancet 1976; i: 168-70.","journal-title":"Lancet"},{"key":"ref_8","first-page":"20","article-title":"Pathophysiological mechanisms of diarrhoea and dumping after vagotomy and pyloroplasty","volume":"10","author":"Krag, E.; Malchow-Moller, A.; Frederiksen, H.J.","year":"1980","unstructured":"Krag E, Malchow-Moller A, Frederiksen HJ, et al. Pathophysiological mechanisms of diarrhoea and dumping after vagotomy and pyloroplasty [Abstract]. 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