TY - JOUR
T1 - Opioid Use and Potency Are Associated With Clinical Features, Quality of Life, and Use of Resources in Patients With Gastroparesis
AU - Gastroparesis Clinical Research Consortium
AU - Hasler, William L.
AU - Wilson, Laura A.
AU - Nguyen, Linda A.
AU - Snape, William J.
AU - Abell, Thomas L.
AU - Koch, Kenneth L.
AU - McCallum, Richard W.
AU - Pasricha, Pankaj J.
AU - Sarosiek, Irene
AU - Farrugia, Gianrico
AU - Grover, Madhusudan
AU - Lee, Linda A.
AU - Miriel, Laura
AU - Tonascia, James
AU - Hamilton, Frank A.
AU - Parkman, Henry P.
AU - Pasricha, Pankaj Jay
AU - Clarke, John
AU - Kim, Yale
AU - Nguyen, Linda
AU - Ullah, Nighat
AU - Snape, William
AU - DeVole, Nata
AU - Greene, Mary
AU - Lee, Candice
AU - Ponsetto, Courtney
AU - Shetler, Katerina
AU - Kantor, Steven
AU - Lytes, Vanessa
AU - Palit, Amiya
AU - Simmons, Kellie
AU - Hejazi, Reza
AU - Roeser, Kathy
AU - Vasquez, Denise
AU - Vega, Natalia
AU - Abell, Thomas
AU - Beatty, Karen
AU - Hatter, Lisa
AU - Howard, Ronna
AU - Nowotny, Lindsay
AU - Tang, Shou
AU - Amin, Om S.
AU - Henry, Olivia
AU - Kedar, Archana
AU - McNair, Valerie
AU - Pruett, Susanne
AU - Smith, Margaret
AU - Sternberg, Alice
AU - Van Natta, Mark
AU - Yates, Katherine
N1 - Funding Information:
Funding This project received support from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK073983, U01DK073975, U01DK073985, U01DK074007, U01DK073974, and U01DK074008) as part of its funding of the Gastroparesis Clinical Research Consortium. Funding This project received support from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK073983, U01DK073975, U01DK073985, U01DK074007, U01DK073974, and U01DK074008) as part of its funding of the Gastroparesis Clinical Research Consortium. The members of the Gastroparesis Clinical Research Consortium are as follows. Clinical centers: Johns Hopkins University, Baltimore, MD: Pankaj Jay Pasricha, MD (Principal Investigator), John Clarke, MD, and Yale Kim, MHS, MS; Stanford University, Stanford, CA: Linda Nguyen, MD (Principal Investigator), and Nighat Ullah, MD; California Pacific Medical Center, San Francisco, CA: William Snape, MD (Principal Investigator), Nata DeVole, RN, Mary Greene (2009–2011), Candice Lee, Courtney Ponsetto (2009–2010), and Katerina Shetler, MD; Temple University, Philadelphia, PA: Henry P. Parkman, MD (Principal Investigator), Steven Kantor, Vanessa Lytes, MSN, CRNP, Amiya Palit, MD, and Kellie Simmons, NP; Texas Tech University Health Sciences Center, El Paso, TX: Richard W. McCallum, MD (Principal Investigator), Reza Hejazi, MD (2009–2011), Kathy Roeser (2008–2009), Irene Sarosiek, MD, Denise Vasquez, RN, and Natalia Vega, RN; University of Louisville, Louisville, KY: Thomas Abell, MD (Principal Investigator), Karen Beatty, RN, Lisa Hatter, RN, Ronna Howard, and Lindsay Nowotny, PA-C; University of Mississippi Medical Center, Jackson, MS: Shou Tang, MD (Principal Investigator), Om S. Amin, MD (2010–2011), Olivia Henry, MS, RD, Archana Kedar, MD, Valerie McNair (2008–2012), Susanne Pruett, RN (2007–2008), Margaret Smith, RN, and Danielle Spree, RN (2007–2010); University of Michigan, Ann Arbor, MI: William Hasler, MD (Principal Investigator), Michelle Castle (2008–2011), Radoslav Coleski, MD (2007–2009), and Sophanara Wootten; Wake Forest University, Winston-Salem, NC: Kenneth Koch, MD (Principal Investigator), Lynn Baxter, Anya Brown, Samantha Culler (2009–2012), Judy Hooker, and Paula Stuart, PA. Resource centers: Mayo Clinic College of Medicine (Pathology Analyses Center), Rochester, MN: Gianrico Farrugia, MD (Principal Investigator), Madhusudan Grover, MD, and Cheryl Bernard; MetroHealth Medical Center, Cleveland, OH: Jorge Calles-Escandon, MD; National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, MD: Jose Serrano, MD, PhD (Program Official), Frank Hamilton, MD, MPH (Project Scientist), Steven James, MD, Rebecca Torrance, RN, MSN, and Rebekah Van Raaphorst, MPH; Johns Hopkins University, Bloomberg School of Public Health (Data Coordinating Center), Baltimore, MD: James Tonascia, PhD (Principal Investigator), Patricia Belt, Erin Corless Hallinan, MHS, Ryan Colvin, MPH (2007–2010), Michele Donithan, MHS, Mika Green, MA (2009–2012), Milana Isaacson, Wana Kim (2009–2011), Linda Lee, MD, Patrick May, MS, Laura Miriel, Alice Sternberg, ScM, Mark Van Natta, MHS, Ivana Vaughn, MPH, Laura Wilson, ScM, and Katherine Yates, ScM. Funding This project received support from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK073983, U01DK073975, U01DK073985, U01DK074007, U01DK073974, and U01DK074008) as part of its funding of the Gastroparesis Clinical Research Consortium.
Publisher Copyright:
© 2019 AGA Institute
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - Abdominal Pain
KW - Diabetes Mellitus
KW - Nausea and Vomiting
KW - Stomach
UR - http://www.scopus.com/inward/record.url?scp=85064819409&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064819409&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2018.10.013
DO - 10.1016/j.cgh.2018.10.013
M3 - Article
C2 - 30326297
AN - SCOPUS:85064819409
SN - 1542-3565
VL - 17
SP - 1285-1294.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 7
ER -