Opioid Use and Potency are Associated with Clinical Features, Quality of Life, and Use of Resources in Patients with Gastroparesis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Hasler, W. L., Wilson, L. A., Nguyen, L. A., Snape, W. J., Abell, T. L., Koch, K. L., McCallum, R. W., Pasricha, P. J., Sarosiek, I., Farrugia, G., Grover, M., Lee, L. A., Miriel, L., Tonascia, J., Hamilton, F. A., Parkman, H. P., Gastroparesis Clinical Research Consortium (GpCRC) 2018


BACKGROUND & AIMS: Many patients with gastroparesis are prescribed opioids for pain control, but indications for opioid prescription and relations 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 healthcare resource use from 583 patients with gastroparesis (more than 10% 4 hr scintigraphic retention) from the NIDDK 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=0.03). 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).CONCLUSION: 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 has 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.

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