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Lipase inhibition by orlistat: effects on gall‐bladder kinetics and cholecystokinin release in obesity
Author(s) -
MathusVliegen E. M. H.,
Van IerlandVan Leeuwen M. L.,
Terpstra A.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2004.01812.x
Subject(s) - orlistat , medicine , gallstones , cholecystokinin , placebo , postprandial , endocrinology , gastric emptying , gastroenterology , weight loss , obesity , insulin , stomach , receptor , alternative medicine , pathology
Summary Background : Obese subjects are at risk of developing gallstones as a result of the obese state and during weight reduction. Aim : To study whether orlistat, by lipase inhibition, impairs gall‐bladder emptying, thus further predisposing weight‐losing obese subjects to gallstone formation. Methods : Patients entering a randomized clinical trial of 1 month of diet, followed by treatment with placebo, 3 × 60 mg orlistat or 3 × 120 mg orlistat, underwent gall‐bladder emptying studies measured by ultrasound. Meal‐induced cholecystokinin release and gall‐bladder emptying were investigated at the start, at randomization and after 1 and 12 months. Results : One month of dieting did not change gall‐bladder emptying and cholecystokinin release. After 1 month, placebo treatment resulted in a decreased fasting volume of 11%, compared with increases of 26% and 47% with 60 and 120 mg orlistat, respectively. Gall‐bladder emptying increased by 9% with placebo and decreased by 15% and 53% with 60 and 120 mg orlistat, respectively. Fasting cholecystokinin values and cholecystokinin release decreased significantly in the orlistat group. After 1 year, a persistent but attenuated effect of orlistat on gall‐bladder emptying and cholecystokinin release remained. Three of 40 patients developed gallstones, two on placebo with major weight loss and one on 60 mg orlistat. Conclusions : One month of lipase inhibition by orlistat significantly impaired gall‐bladder motility, which persisted to some extent after 1 year. Obese subjects with diabetes or hyperlipidaemia, who are more at risk of gallstones, should be followed carefully.