Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2017; 23(40): 7310-7320
Published online Oct 28, 2017. doi: 10.3748/wjg.v23.i40.7310
Chronic opioids in gastroparesis: Relationship with gastrointestinal symptoms, healthcare utilization and employment
Asad Jehangir, Henry P Parkman
Asad Jehangir, Department of Internal Medicine, Reading Health System, Spruce St/6th Ave, West Reading, PA 19611, United States
Asad Jehangir, Henry P Parkman, Department of Gastroenterology, Temple University Hospital, Philadelphia, PA 19140, United States
Author contributions: Jehangir A collected and analyzed the data, did literature review, and wrote the manuscript; Parkman HP planned the study, evaluated the patients included in the study, did literature review, and helped write the manuscript; both authors approve the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Temple University Hospital Intuitional Review Board.
Informed consent statement: Study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Henry P Parkman, MD, Professor of Medicine, Department of Gastroenterology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, United States. henry.parkman@tuhs.temple.edu
Telephone: +1-215-7642609 Fax: +1-215-7072684
Received: July 31, 2017
Peer-review started: August 1, 2017
First decision: August 30, 2017
Revised: September 8, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: October 28, 2017
Processing time: 90 Days and 4.9 Hours
Abstract
AIM

To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in gastroparesis (Gp) patients.

METHODS

Patients referred to our tertiary care academic center from May 2016 to July 2017, with established diagnosis or symptoms suggestive of Gp filled out the Patient Assessment of Upper GI Symptoms, abdominal pain and demographics questionnaires, and underwent gastric emptying and blood tests. They were asked about taking pain medicines and the types, doses, and duration. We used Mann Whitney U test, Analysis of Variance, Student’s t test and χ2 tests where appropriate for data analyses.

RESULTS

Of 223 patients with delayed gastric emptying, 158 (70.9%) patients were not taking opioids (GpNO), 22 (9.9%) were taking opioids only as needed, while 43 (19.3%) were on chronic (> 1 mo) scheduled opioids (GpCO), of which 18 were taking opioids for reasons that included gastroparesis and/or stomach pain. Median morphine equivalent use was 60 mg per day. GpCO reported higher severities of many gastrointestinal symptoms compared to GpNO including nausea (mean ± SE of mean of 4.09 ± 0.12 vs 3.41 ± 0.12, P = 0.011), retching (2.86 ± 0.25 vs 1.98 ± 0.14, P = 0.003), vomiting (2.93 ± 0.24 vs 2.07 ± 0.15, P = 0.011), early satiety (4.17 ± 0.19 vs 3.57 ± 0.12, P = 0.004), post-prandial fullness (4.14 ± 0.18 vs 3.63 ± 0.11, P = 0.022), loss of appetite (3.64 ± 0.21 vs 3.04 ± 0.13, P = 0.039), upper abdominal pain (3.86 ± 0.20 vs 2.93 ± 0.13, P = 0.001), upper abdominal discomfort (3.74 ± 0.19 vs 3.09 ± 0.13, P = 0.031), heartburn during day (2.55 ± 0.27 vs 1.89 ± 0.13, P = 0.032), heartburn on lying down (2.76 ± 0.28 vs 1.94 ± 0.14, P = 0.008), chest discomfort during day (2.42 ± 0.20 vs 1.83 ± 0.12, P = 0.018), chest discomfort at night (2.40 ± 0.23 vs 1.61 ± 0.13, P = 0.003), regurgitation/reflux during day (2.77 ± 0.25 vs 2.18 ± 0.13, P = 0.040) and bitter/acid/sour taste in the mouth (2.79 ± 0.27 vs 2.11 ± 0.14, P = 0.028). GpCO had a longer duration of nausea per day (median of 7 h vs 4 h for GpNO, P = 0.037), and a higher number of vomiting episodes per day (median of 3 vs 2 for GpNO, P = 0.002). Their abdominal pain more frequently woke them up at night (78.1% vs 57.3%, P = 0.031). They had a lower employment rate (33.3% vs 54.2%, P = 0.016) and amongst those who were employed less number of working hours per week (median of 23 vs 40, P = 0.005). They reported higher number of hospitalizations in the last 1 year (mean ± SE of mean of 2.90 ± 0.77 vs 1.26 ± 0.23, P = 0.047).

CONCLUSION

GpCO had a higher severity of many gastrointestinal symptoms, compared to GpNO. Hospitalization rates were more than 2-fold higher in GpCO than GpNO. GpCO also had lower employment rate and working hours, when compared to GpNO.

Keywords: Opioid; Gastroparesis; Symptoms; Hospitalizations; Employment

Core tip: Chronic opioid use can cause gastrointestinal side effects and negatively influence the quality of life. The impact of chronic opioid use on symptoms, healthcare utilization, and employment of gastroparesis patients is not well studied. In our study, gastroparesis patients on chronic scheduled opioids had more severe gastrointestinal symptoms, less work productivity and more frequent hospitalizations compared to gastroparesis patients without opioid use. Whether opioid use is to treat a higher symptom severity from gastroparesis, or the opioid use worsens symptoms requires further study.