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
ARTICLE HIGHLIGHTS
Research frontiers

Despite the gastrointestinal side effects associated with opioid use, they are used in some patients with gastroparesis. The relationship of opioid use to the gastrointestinal symptoms, healthcare utilization and employment is not known.

Research motivation

As opioid use had become a healthcare epidemic in United States, studies on opioid use in gastroparesis would be useful for clinicians and researchers.

Research objectives

This objective was to study the relationship of chronic scheduled opioid use to gastrointestinal symptoms, healthcare utilization and employment in gastroparesis patients.

Research methods

The authors used Mann Whitney U Test, Student’s t-test, Analysis of Variance, and χ2 test as appropriate for data analysis.

Research results

This study shows higher severity of many gastrointestinal symptoms, and more frequent hospitalizations in gastroparesis patients on chronic scheduled opioids, compared to gastroparesis patients not using opioids. Chronic opioid using patients also reported their work being effected more frequently by their gastrointestinal symptoms. The prevalence of chronic pancreatitis is also higher in opioid using gastroparesis patients.

Research conclusions

This study confirmed the hypothesis that chronic opioid use in gastroparesis is related with more severe gastrointestinal symptoms, and hospitalizations. Whether opioid use is to manage a higher severity of gastroparesis symptoms, or is responsible for the higher severity of symptoms is not clear as we did not have symptoms of patients prior to starting opioids. In clinical practice, this study implicates that the opioids may need to be used with caution in gastroparesis patients.

Research perspectives

Opioid use is quite prevalent in patients with gastroparesis. Opioid-using gastroparesis patients have more severe gastrointestinal symptoms. These opioid-using patients are more frequently hospitalized, compared to the patients without opioid use. They also more commonly report their employment being affected due to their gastrointestinal symptoms. Patients with gastroparesis may have chronic pancreatitis, possibly contributing to their gastrointestinal symptoms.

Future studies can look into the trends of laxative-use in opioid-using gastroparesis patients. The noticeable prevalence of chronic pancreatitis in gastroparesis patients in this study can be further confirmed in studies with larger sample size. This study found more frequent hospitalizations in gastroparesis patients; future studies to evaluate opioid use during hospitalizations in gastroparesis patients will add useful information to the current literature on gastroparesis.

Future research can look into opioid use in gastroparesis through different perspectives, this could be not only in the tertiary care centers, but also in smaller community settings so that the results more accurately reflect the generalized population. Moreover, bigger databases using diagnosis codes and medication-lists can be used to get a larger sample size.