Opioid Use and Potency Are Associated With Clinical Features, Quality of Life, and Use of Resources in Patients With Gastroparesis
William L Hasler, Laura A Wilson, Linda A Nguyen, William J Snape, Thomas L Abell, Kenneth L Koch, Richard W McCallum, Pankaj J Pasricha, Irene Sarosiek, Gianrico Farrugia, Madhusudan Grover, Linda A Lee, Laura Miriel, James Tonascia, Frank A Hamilton, Henry P Parkman, Gastroparesis Clinical Research Consortium, Pankaj Jay Pasricha, John Clarke, Yale Kim, Linda Nguyen, Nighat Ullah, William Snape, Nata DeVole, Mary Greene, Candice Lee, Courtney Ponsetto, Katerina Shetler, Henry P Parkman, Steven Kantor, Vanessa Lytes, Amiya Palit, Kellie Simmons, Richard W McCallum, Reza Hejazi, Kathy Roeser, Irene Sarosiek, Denise Vasquez, Natalia Vega, Thomas Abell, Karen Beatty, Lisa Hatter, Ronna Howard, Lindsay Nowotny, Shou Tang, Om S Amin, Olivia Henry, Archana Kedar, Valerie McNair, Susanne Pruett, Margaret Smith, Danielle Spree, William Hasler, Michelle Castle, Radoslav Coleski, Sophanara Wootten, Kenneth Koch, Lynn Baxter, Anya Brown, Samantha Culler, Judy Hooker, Paula Stuart, Gianrico Farrugia, Madhusudan Grover, Cheryl Bernard, Jorge Calles-Escandon, Jose Serrano, Frank Hamilton, Steven James, Rebecca Torrance, Rebekah Van Raaphorst, James Tonascia, Patricia Belt, Erin Corless Hallinan, Ryan Colvin, Michele Donithan, Mika Green, Milana Isaacson, Wana Kim, Linda Lee, Patrick May, Laura Miriel, Alice Sternberg, Mark Van Natta, Ivana Vaughn, Laura Wilson, Katherine Yates, William L Hasler, Laura A Wilson, Linda A Nguyen, William J Snape, Thomas L Abell, Kenneth L Koch, Richard W McCallum, Pankaj J Pasricha, Irene Sarosiek, Gianrico Farrugia, Madhusudan Grover, Linda A Lee, Laura Miriel, James Tonascia, Frank A Hamilton, Henry P Parkman, Gastroparesis Clinical Research Consortium, Pankaj Jay Pasricha, John Clarke, Yale Kim, Linda Nguyen, Nighat Ullah, William Snape, Nata DeVole, Mary Greene, Candice Lee, Courtney Ponsetto, Katerina Shetler, Henry P Parkman, Steven Kantor, Vanessa Lytes, Amiya Palit, Kellie Simmons, Richard W McCallum, Reza Hejazi, Kathy Roeser, Irene Sarosiek, Denise Vasquez, Natalia Vega, Thomas Abell, Karen Beatty, Lisa Hatter, Ronna Howard, Lindsay Nowotny, Shou Tang, Om S Amin, Olivia Henry, Archana Kedar, Valerie McNair, Susanne Pruett, Margaret Smith, Danielle Spree, William Hasler, Michelle Castle, Radoslav Coleski, Sophanara Wootten, Kenneth Koch, Lynn Baxter, Anya Brown, Samantha Culler, Judy Hooker, Paula Stuart, Gianrico Farrugia, Madhusudan Grover, Cheryl Bernard, Jorge Calles-Escandon, Jose Serrano, Frank Hamilton, Steven James, Rebecca Torrance, Rebekah Van Raaphorst, James Tonascia, Patricia Belt, Erin Corless Hallinan, Ryan Colvin, Michele Donithan, Mika Green, Milana Isaacson, Wana Kim, Linda Lee, Patrick May, Laura Miriel, Alice Sternberg, Mark Van Natta, Ivana Vaughn, Laura Wilson, Katherine Yates
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.
Keywords: Abdominal Pain; Diabetes Mellitus; Nausea and Vomiting; Stomach.
Conflict of interest statement
Conflicts of interest
The authors disclose no conflicts.
Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.
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Source: PubMed