Lipase inhibition by orlistat: effects on gall-bladder kinetics and cholecystokinin release in obesity
Authors: Mathus-Vliegen, E. M. H.1; Van Ierland-Van Leeuwen, M. L.2; Terpstra, A.1
Source: Alimentary Pharmacology & Therapeutics, Volume 19, Number 5, March 2004 , pp. 601-611(11)
Publisher: Blackwell Publishing
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Abstract:
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.Document Type: Research article
DOI: 10.1046/j.1365-2036.2004.01812.x
Affiliations: 1: Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 2: Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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