Diagnosis, Characterization, and 3-Month Outcome After Detoxification of 39 Patients With Narcotic Bowel Syndrome

Drossman, Douglas A.; Morris, Carolyn; Edwards, H. A.; Wrennall, Christina E.; Weinland, Stephan R.; Aderoju, Ademola O.; Kulkarni-Kelapure, Renuka R.; Hu, Yuming; Dalton, Christine B.; Bouma, Megan H.; Zimmerman, Joseph; Rooker, Ceciel; Leserman, Jane; Bangdiwala, Shrikant I.

doi:10.1038/ajg.2012.142

Cited by 54 publications

(48 citation statements)

References 21 publications

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“…Chronic opioid use may be particularly detrimental for this population, as chronic opioid exposure may actually worsen abdominal pain due to opioid induction of hyperalgesia, 11 and aggravation of IBS symptoms via alterations in intestinal transit and development of narcotic bowel syndrome. [12][13][14] IBS patients using prescription opioids report more severe GI symptoms, as well as poorer IBS-related and general…”

Section: Introductionmentioning

confidence: 99%

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Sayuk

Kanuri

Gyawali

et al. 2018

Aliment Pharmacol Ther

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SummaryBackgroundWhile opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit.AimTo compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role.MethodsVeterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups.ResultsA greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use.ConclusionsDespite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.

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Section: Introductionmentioning

confidence: 99%

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Sayuk

Kanuri

Gyawali

et al. 2018

Aliment Pharmacol Ther

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“…In this category, Drossman et al reported on the use of a detoxification program implemented by a multi-disciplinary provider team to reduce opioid use and treat narcotic bowel syndrome [67]. Thirty-nine patients with narcotic bowel syndrome were placed on a two-year detoxification program; 58% of these patients also had structural GI diagnoses, including IBD and pancreatitis, and/or functional GI diagnoses, including IBS and functional abdominal pain.…”

Section: Resultsmentioning

confidence: 99%

“…Approximately 45% of patients, however, reverted back to opioid use three months after detoxification. Drossman et al concluded that, despite the promise of detoxification programs, further investigation is needed to understand the high rate of relapse in opioid use [67]. …”

Section: Resultsmentioning

confidence: 99%

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

Balbale

Trivedi²,

O’Dwyer

et al. 2017

Dig Dis Sci

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Background Scoping reviews are preliminary assessments intended to characterize the extent and nature of emerging research evidence, identify literature gaps, and offer directions for future research. We conducted a systematic scoping review to describe published scientific literature on strategies to identify and reduce opioid misuse among patients with gastrointestinal (GI) symptoms and disorders. Methods We performed structured keyword searches to identify manuscripts published through June 2016 in the PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases to extract original research articles that described health care practices, tools or interventions to identify and reduce opioid misuse among GI patients. The Chronic Care Model (CCM) was used to classify the strategies presented. Results Twelve articles met the inclusion criteria. A majority of studies used quasi-experimental or retrospective cohort study designs. Most studies addressed the CCM’s clinical information systems element. Seven studies involved identification of opioid misuse through prescription drug monitoring and opioid misuse screening tools. Four studies discussed reductions in opioid use by harnessing drug monitoring data and individual care plans, and implementing self-management and opioid detoxification interventions. One study described drug monitoring and an audit-and-feedback intervention to both identify and reduce opioid misuse. Greatest reductions in opioid misuse were observed when drug monitoring, self-management, or audit-and-feedback interventions were used. Conclusions Prescription drug monitoring and self-management interventions may be promising strategies to identify and reduce opioid misuse in gastrointestinal care. Rigorous, empirical research is needed to evaluate the longer-term impact of these strategies.

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“…Perforation-Peptic Ulcer, Typhoid Ulcer, Diverticular Disease, Ulcerative Colitis etc. [52,53,54,55] 5. Tortion Of Pedicle e.g Twisted Ovarian Cyst, Spleen etc.…”

Section: "Pain Abdomen:differential Diagnosis" (A)intra-abdominalmentioning

confidence: 99%

“Recurrent Lower Abdomen Pain, An Introspection.”

Sahni¹

2013

IOSR-JPBS

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Diagnosis, Characterization, and 3-Month Outcome After Detoxification of 39 Patients With Narcotic Bowel Syndrome

Cited by 54 publications

References 21 publications

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

“Recurrent Lower Abdomen Pain, An Introspection.”

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