APPETITE STIMULATIONThis is often difficult, as patients with a poor appetite may
have a debilitating systemic illness or an underlying psychi-
atric disorder. Drugs that inhibit serotonin (5HT) receptors,
(e.g.cyproheptadine,pizotifen) increase appetite and cause
weight gain. Weight gain occurs during treatment with various
other drugs, including atypical neuroleptics, e.g. risperidone,
amitriptyline,lithium, glucocorticosteroids and ACTH, as
well as the oral contraceptive pill. Glucocorticosteroids may
help to improve appetite in terminally ill patients.FURTHER READING
Bateson MC. Advances in gastroenterology and hepatology.
Postgraduate Medical Journal2000; 76 : 328–32.
Reidenburg M. Drugs and the liver. British Journal of Clinical
Pharmacology1998; 46 : 351–9.
Zaman A, Chalasani N. Bleeding caused by portal hypertension.
Gastroenterology Clinics of North America2005; 34 : 623–42.264 ALIMENTARY SYSTEM ANDLIVER
discharge, faecal urgency and oily faeces. Although there is
less absorption of the fat-soluble vitamins (vitamins A, D, E
and K) and of β-carotene, this does not appear to cause patho-
logical vitamin deficiency, and vitamin supplementation is
not routinely indicated.
BULK AGENTS
Substances such as methylcellulose and guar gum act as bulk-
ing agents in the diet and are ineffective at producing weight
loss. A high-fibre diet may help weight loss, provided that
total caloric intake is reduced, and is desirable for other rea-
sons as well.
MISCELLANEOUS
Diuretics cause a transient loss of weight through fluid loss,
and their use for such an effect is to be deplored. Myxoedema
is associated with weight gain. Thyroxine has been used to
increase the basal metabolic rate and reduce weight in euthy-
roid obese patients. This is both dangerous and irrational.