Impact of Opioid Consumption in Patients With Functional Gastrointestinal Disorders.

Chloé Melchior,Anne-Marie Leroi,Fabien Wuestenberghs,Charlotte Desprez,Guillaume Goucerol,Antoine Lemaire

doi:10.3389/fphar.2020.596467

Abstract

Objective: We aimed to determine the burden of opioid consumption in a cohort of patients with functional gastrointestinal disorders. Methods: All patients diagnosed with functional gastrointestinal disorders and referred to our university hospital were evaluated from 2013 to the beginning of 2019. Irritable bowel syndrome and functional dyspepsia diagnoses were determined according to Rome criteria and severity according to irritable bowel syndrome severity scoring system. Vomiting was quantified using a 5-point Likert scale, and constipation severity was measured using the Knowles-Eccersley-Scott-Symptom questionnaires. Quality of life was quantified by the GastroIntestinal Quality of Life Index. Patients were categorized as being treated on a chronic basis with either tramadol, step II opioids, step III opioids or as being opioid-free. Results: 2933 consecutive patients were included. In our cohort, 12.5% had only irritable bowel syndrome, 39.3% had only functional dyspepsia, 24.9% had a combination of both, and 23.4% had other functional gastrointestinal disorders. Among them, the consumption of tramadol, step II (tramadol excluded) and step III opioids was 1.8, 1.3 and 0.3 % respectively in 2013 and 4.3, 3.4 and 1.9% in 2018 (p < 0.03). Opioid consumption was associated with increased vomiting (p = 0.0168), constipation (p < 0.0001), symptom severity (p < 0.001), more altered quality of life (p < 0.0001) and higher depression score (p = 0.0045). Conclusion: In functional gastrointestinal disorders, opioid consumption has increased in the last years and is associated with more GI symptoms (vomiting, constipation and GI severity), higher depression and more altered quality of life.

Highlights

Opioids are mostly prescribed for acute or chronic pain associated or not with cancer referring to the World Health Organization guidelines for pain evaluation
1096 patients responded to the Rome questionnaire, 12.5% had only Irritable bowel syndrome (IBS), 39.3% had only functional dyspepsia (FD), 24.9% had a combination of IBS and FD, and 23.4% had other functional GI disorders (FGID)
As reported in Europe in a global population (Bosetti et al, 2019), we have shown an increase in opioid consumption over the years in FGID patients

Summary

Introduction

Opioids are mostly prescribed for acute or chronic pain associated or not with cancer referring to the World Health Organization guidelines for pain evaluation. Step III (morphine, oxycodone, fentanyl, etc.) and step II (tramadol, codeine, etc) opioid consumption increased by 45% and 65% respectively between 2006 and 2017 in the United States (Vadivelu et al, 2018). Opioid-induced constipation (OIC) is the most frequent side effect and is defined by Rome IV criteria (Mearin et al, 2016). Considering their gastrointestinal (GI) side effects, and the lack of efficacy to relieve pain in functional GI disorders (FGID), opioids are not recommended in the treatment of painful FGID (Szigethy et al, 2018). There are currently few studies reporting opioid consumption trends in FGID patients, and the impact of opioids on GI symptoms and quality of life in FGID patients still needs to be assessed

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Results

Discussion

Conclusion