William L Hasler1, Laura A Wilson2, Linda A Nguyen3, William J Snape4, Thomas L Abell5, Kenneth L Koch6, Richard W McCallum7, Pankaj J Pasricha8, Irene Sarosiek7, Gianrico Farrugia9, Madhusudan Grover9, Linda A Lee2, Laura Miriel2, James Tonascia2, Frank A Hamilton10, Henry P Parkman11. 1. Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan. Electronic address: whasler@umich.edu. 2. Data Coordinating Center, Johns Hopkins University, Baltimore, Maryland. 3. Division of Gastroenterology, Stanford University, Palo Alto, California. 4. Division of Gastroenterology, California Pacific Medical Center, San Francisco, California. 5. Division of Gastroenterology, University of Louisville, Louisville, Kentucky. 6. Section on Gastroenterology, Wake Forest University, Winston Salem, North Carolina. 7. Section of Gastroenterology, Texas Tech University, El Paso, Texas. 8. Section of Gastroenterology, Johns Hopkins University, Baltimore, Maryland. 9. Section of Gastroenterology, Mayo Clinic, Rochester, Minnesota. 10. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. 11. Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania.
Abstract
BACKGROUND & AIMS: Many patients with gastroparesis are prescribed opioids for pain control, but indications for opioid prescriptions and the relationship of opioid use to gastroparesis manifestations are undefined. We characterized associations of use of potent vs weaker opioids and presentations of diabetic and idiopathic gastroparesis. METHODS: We collected data on symptoms, gastric emptying, quality of life, and health care resource use from 583 patients with gastroparesis (>10% 4-h scintigraphic retention) from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Consortium, from January 2007 through November 2016. Patients completed medical questionnaires that included questions about opioid use. The opioid(s) were categorized for potency relative to oral morphine. Symptom severities were quantified by Patient Assessment of Upper Gastrointestinal Disorders Symptoms questionnaires. Subgroup analyses compared patients on potent vs weaker opioids and opioid effects in diabetic vs idiopathic etiologies. RESULTS: Forty-one percent of patients were taking opioids; 82% of these took potent agents (morphine, hydrocodone, oxycodone, methadone, hydromorphone, buprenorphine, or fentanyl). Abdominal pain was the reason for prescription for 61% of patients taking opioids. Mean scores for gastroparesis, nausea/vomiting, bloating/distention, abdominal pain, and constipation scores were higher in opioid users (P ≤ .05). Opioid use was associated with greater levels of gastric retention, worse quality of life, increased hospitalization, and increased use of antiemetic and pain modulator medications compared with nonusers (P ≤ .03). Use of potent opioids was associated with worse gastroparesis, nausea/vomiting, upper abdominal pain, and quality-of-life scores, and more hospitalizations compared with weaker opioids (tapentadol, tramadol, codeine, or propoxyphene) (P ≤ .05). Opioid use was associated with larger increases in gastric retention in patients with idiopathic vs diabetic gastroparesis (P = .008). CONCLUSIONS: Opioid use is prevalent among patients with diabetic or idiopathic gastroparesis, and is associated with worse symptoms, delays in gastric emptying, and lower quality of life, as well as greater use of resources. Potent opioids are associated with larger effects than weaker agents. These findings form a basis for studies to characterize adverse outcomes of opioid use in patients with gastroparesis and to help identify those who might benefit from interventions to prevent opioid overuse.
BACKGROUND & AIMS: Many patients with gastroparesis are prescribed opioids for pain control, but indications for opioid prescriptions and the relationship of opioid use to gastroparesis manifestations are undefined. We characterized associations of use of potent vs weaker opioids and presentations of diabetic and idiopathic gastroparesis. METHODS: We collected data on symptoms, gastric emptying, quality of life, and health care resource use from 583 patients with gastroparesis (>10% 4-h scintigraphic retention) from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Consortium, from January 2007 through November 2016. Patients completed medical questionnaires that included questions about opioid use. The opioid(s) were categorized for potency relative to oral morphine. Symptom severities were quantified by Patient Assessment of Upper Gastrointestinal Disorders Symptoms questionnaires. Subgroup analyses compared patients on potent vs weaker opioids and opioid effects in diabetic vs idiopathic etiologies. RESULTS: Forty-one percent of patients were taking opioids; 82% of these took potent agents (morphine, hydrocodone, oxycodone, methadone, hydromorphone, buprenorphine, or fentanyl). Abdominal pain was the reason for prescription for 61% of patients taking opioids. Mean scores for gastroparesis, nausea/vomiting, bloating/distention, abdominal pain, and constipation scores were higher in opioid users (P ≤ .05). Opioid use was associated with greater levels of gastric retention, worse quality of life, increased hospitalization, and increased use of antiemetic and pain modulator medications compared with nonusers (P ≤ .03). Use of potent opioids was associated with worse gastroparesis, nausea/vomiting, upper abdominal pain, and quality-of-life scores, and more hospitalizations compared with weaker opioids (tapentadol, tramadol, codeine, or propoxyphene) (P ≤ .05). Opioid use was associated with larger increases in gastric retention in patients with idiopathic vs diabetic gastroparesis (P = .008). CONCLUSIONS: Opioid use is prevalent among patients with diabetic or idiopathic gastroparesis, and is associated with worse symptoms, delays in gastric emptying, and lower quality of life, as well as greater use of resources. Potent opioids are associated with larger effects than weaker agents. These findings form a basis for studies to characterize adverse outcomes of opioid use in patients with gastroparesis and to help identify those who might benefit from interventions to prevent opioid overuse.
Authors: J Hardy; S Daly; B McQuade; M Albertsson; V Chimontsi-Kypriou; P Stathopoulos; P Curtis Journal: Support Care Cancer Date: 2002-02-09 Impact factor: 3.603
Authors: Christine de la Loge; Elyse Trudeau; Patrick Marquis; Peter Kahrilas; Vincenzo Stanghellini; Nicholas J Talley; Jan Tack; Dennis A Revicki; Anne M Rentz; Dominique Dubois Journal: Qual Life Res Date: 2004-12 Impact factor: 4.147
Authors: A M Rentz; P Kahrilas; V Stanghellini; J Tack; N J Talley; C de la Loge; E Trudeau; D Dubois; D A Revicki Journal: Qual Life Res Date: 2004-12 Impact factor: 4.147
Authors: G Tougas; E Y Eaker; T L Abell; H Abrahamsson; M Boivin; J Chen; M P Hocking; E M Quigley; K L Koch; A Z Tokayer; V Stanghellini; Y Chen; J D Huizinga; J Rydén; I Bourgeois; R W McCallum Journal: Am J Gastroenterol Date: 2000-06 Impact factor: 10.864
Authors: Jonathan Gonenne; Michael Camilleri; Irene Ferber; Duane Burton; Kari Baxter; Kian Keyashian; Joseph Foss; Bruce Wallin; Wei Du; Alan R Zinsmeister Journal: Clin Gastroenterol Hepatol Date: 2005-08 Impact factor: 11.382
Authors: D A Revicki; A M Rentz; D Dubois; P Kahrilas; V Stanghellini; N J Talley; J Tack Journal: Aliment Pharmacol Ther Date: 2003-07-01 Impact factor: 8.171
Authors: Michael Camilleri; Braden Kuo; Linda Nguyen; Vida M Vaughn; Jessica Petrey; Katarina Greer; Rena Yadlapati; Thomas L Abell Journal: Am J Gastroenterol Date: 2022-06-03 Impact factor: 12.045
Authors: Gerardo Calderon; Robert M Siwiec; Matthew E Bohm; Thomas V Nowak; John M Wo; Anita Gupta; Huiping Xu; Andrea Shin Journal: Dig Dis Sci Date: 2020-03-02 Impact factor: 3.199
Authors: Jolien Schol; Lucas Wauters; Ram Dickman; Vasile Drug; Agata Mulak; Jordi Serra; Paul Enck; Jan Tack Journal: United European Gastroenterol J Date: 2021-04 Impact factor: 4.623