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CLINICAL CHARACTERISTICS AND OUTCOMES OF CONSECUTIVE PATIENTS WITH FUNCTIONAL DYSPEPSIA TAKING OPIOIDS REFERRED TO A UK TERTIARY CARE HOSPITAL

Mohsin Butt 1,2, Arkadeep Dhali 3, Grace Isherwood 1, Tilly Lewis-Lawson 1, Unknown Unknown 1, Timothy R. Card 1, Maura Corsetti 1

Affiliations

1 University of Nottingham, Nottinghamshire, United Kingdom

2 Queen Mary University of London, London, United Kingdom

3 NIHR Nottingham Digestive Diseases Centre, Nottinghamshire, United Kingdom

Summary

AI Generated

A retrospective UK tertiary care audit found that among 157 patients with Rome IV functional dyspepsia, 34 were taking opioids and experienced significantly higher rates of nausea, vomiting, and constipation compared to non-opioid users.

Among 157 consecutive Rome IV functional dyspepsia patients at a UK tertiary neurogastroenterology unit (2016-2021), 34 were prescribed opioids.
Opioid users had significantly more nausea (82.4% versus 61%, p=0.02), vomiting (55.9% versus 27.6%, p=0.002), and constipation (52.9% versus 23.6%, p=0.001) than non-users.
Of 32 opioid users advised to stop, only 15 (46.8%) did so; among those who stopped, 9 (60%) reported symptom improvement, most commonly reduced constipation, reduced pain, or feeling generally better.
Healthcare utilization showed no significant difference between groups in number of specialist consultations or investigations performed.
The authors suggest that most functional dyspepsia patients in tertiary care do not follow opioid cessation advice and that reducing opioid prescriptions for chronic non-cancer pain may be beneficial.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Functional dyspepsia (FD) has an estimated population prevalence of 10% using the ROME IV criteria (1). Opioids have a limited therapeutic role in the management of non-malignant pain, but the opioid prescription rates for the management of non-cancer pain has increased steadily by 0.5% per year from 2006 to 2016 (2). Opioid induced hyperalgesia is thought to contribute to the development of visceral hypersensitivity in patients with disorders of gut-brain interaction (DGBIs) (3). To our knowledge, no UK study has yet addressed the clinical characteristics and healthcare outcomes of patients diagnosed with clinically confirmed ROME IV FD who are prescribed opioids.

Aims & Methods

The primary aim of this study is to determine the proportion of patients diagnosed with ROME IV FD in a tertiary care neurogastroenterology setting who are prescribed opioids. The secondary aims of the study are as follows: to determine the differences in clinical characteristics and symptomatology between patients with FD taking opioids compared to those not taking opioids; to determine the differences in healthcare utilisation (i.e., number of investigations, clinic consultations, and hospitalisations) between patients taking opioids compared to those not taking opioids; and to determine the proportion of patients who adhere to opioid cessation advice and whether their clinical symptoms improve.
This study was approved as a retrospective audit (Nottingham University Hospitals NHS Trust registration number 21-482C). Data were analysed from consecutive patients who presented to a single tertiary care neurogastroenterology unit (Queen’s Medical Centre, Nottinghamshire, UK) between January 2016 – December 2021 and diagnosed with FD according to the Rome IV clinical diagnostic criteria. Only patients aged ≥ 18 were included and pregnancy was the only exclusion factor. Phenotype and clinical outcomes were compared between FD patients taking opioids and those not taking opioids.

Results

A total of 157 patients were diagnosed with ROME IV FD. Among these 157 patients, 34 were classified in the opioid group and the remainder (n=123) in the non-opioid group. Nausea (n=28, 82.4% versus n=75, 61%; p=0.02), vomiting (n=19, 55.9% versus n=34, 27.6%; p=0.002), and constipation (n=18, 52.9% versus n=21, 23.6%; p=0.001) were most commonly seen in the opioid group. There was no intergroup difference in the number of specialist consultations (p=0.45), or number of investigations (p=0.14) that the patients underwent. In the opioid group (n=34), 32 (94.1%) patients were advised to stop opioids. Fifteen (46.8%) stopped taking opioids on advice and nine (60%) of these patients who stopped opioids reported improvement in symptoms. The most commonly reported symptom improvement was reduced constipation (n=3, 33.3%), reduced pain (n=3, 33.3%), or general feeling better (n=3, 33.3%). Approximately half of the patients who did not stop taking opioids reported that they needed the drugs for pain relief, whilst the remaining did not provide an explanation.

Conclusion

We demonstrate that opioid intake in FD is associated with more nausea, vomiting, and constipation compared to patients who are not prescribed opioids. We also show that most patients with ROME IV FD in a tertiary care setting often do not follow opioid cessation advice. Should the burden of opioids in patients diagnosed with DGBIs be as high as this study suggests, then it is possible that an appreciable part of this disease burden may be avoidable via the strict implementation of policies to reduce opioid prescriptions for chronic non-cancer pain.

References

(1) Aziz I, Palsson OS, Tornblom H, Sperber AD, Whitehead WE, Simren M. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol. 2018;3(4):252-62.
(2) LeBrett WG, Chen FW, Yang L, Chang L. Increasing Rates of Opioid Prescriptions for Gastrointestinal Diseases in the United States. The American journal of gastroenterology. 2021;116(4).
(3) Farmer AD, Gallagher J, Bruckner-Holt C, Aziz Q. Narcotic bowel syndrome. The lancet Gastroenterology & hepatology. 2017;2(5).

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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ROME V GLOBAL EPIDEMIOLOGY SURVEY

Ami D. Sperber 1, Jóhann Hreinsson 2, Magnus Simrén 3, Douglas Drossman 4, Viola Andresen 5, Serhat Bor 6, Dan Lucian Dumitrascu 7, Xiucai Fang 8, Guijun Fei 8, Luis Bustos Fernandez 9, Carlos de Magalhaes Francisconi 10, Shin Fukudo 11, Sang-Kil Lee 12, Chloé Melchior 13, Agata Mulak 14, Anne Peery 15, David Mario Rodrigues 16, Javier Santos 17, Max Julio Schmulson Wasserman 18, Dipesh H Vasant 19, Jan Tack 20, Olafur S. Palsson 21

Affiliations

1 Ben-Gurion University of the Negev, Beer-Sheva, Israel

2 Sahlgrenska University Hospital, Gothenburg, Sweden

3 Sahlgrenska University Hospital - Dept of Internal Medicine, Sahlgrenska University Hospital ; Gothe, Gothenburg, Sweden

4 Drossman Gastroenterology - Drossman Gastroenterology, Drossman Gastroenterology; Chapel Hill/US, Chapel Hill, United States

5 Israelitisches Krankenhaus Hamburg/DE, Hamburg, Germany

6 Ege University Dept of Gastroenterology Ege Reflux Study Group, Izmir, Türkiye

7 Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania

8 Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

9 CMBF, Buenos Aires, Argentina

10 Hospital de Clínicas Porto Alegre Dept. of Gastroenterology, Porto Alegre, Brazil

11 Tohoku University Graduate School of Medicine, Sendai, Japan

12 Yonsei University College of Medicine, Severance Hospital, Seoul, Korea, Republic of

13 Rouen University Hospital, INSERM U1073, CIC-CRB-1404, Rouen, France

14 Katedra I Klinika Gastroenterologii I Hepatologii Uniwersytet Medyczny Wroclaw, Wroclaw, Poland

15 University of North Carolina at Chapel Hill, Chapel Hill, United States

16 Queen's University, Kingston, ON, Canada

17 Institut de Recerca Vall d`Hebron, Barcelona, Spain

18 Dr. Ruy Pérez Tamayo (UME), Faculty of Medicine, Universidad Nacional Autónoma de Mexico (UNAM). Hospital General de México, Mexico City, Mexico

19 Manchester University Foundation Trust, Manchester, United Kingdom

20 University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

21 University of North Carolina, Chapel Hill, Chapel Hill, NC, United States