Impact of Opioid Use on the Natural History of Inflammatory Bowel Disease: Prospective Longitudinal Follow-up Study
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All Authors
Riggott,Christy
Fairbrass,Keeley M.
Selinger,Christian P.
Gracie,David J.
Ford,Alexander C.
LTHT Author
Riggott, Christy
Selinger, Christian
Gracie, David
Ford, Alex
Selinger, Christian
Gracie, David
Ford, Alex
LTHT Department
Abdominal Medicine & Surgery
Gastroenterology
Drs Rotation
Gastroenterology
Drs Rotation
Non Medic
Publication Date
2024
Item Type
Article
Language
Subject
Subject Headings
Abstract
Background Opioid use is increasingly prevalent amongst patients with inflammatory bowel disease (IBD), but whether opioids have deleterious effects, or their use is merely linked with more severe disease, is unclear. We conducted a longitudinal follow-up study examining this issue. Methods Data on demographics, gastrointestinal and psychological symptoms, quality of life, and opioid use were recorded at baseline. Data on healthcare use and adverse disease outcomes were obtained from a review of electronic medical records at 12 months. Characteristics at baseline of those using opioids and those who were not were compared, in addition to occurrence of flare, prescription of glucocorticosteroids, treatment escalation, hospitalization, or intestinal resection during the 12 months of follow-up. Results Of 1029 eligible participants, 116 (11.3%) were taking opioids at baseline. Medium (odds ratio OR],?4.67; 95% confidence interval CI], 1.61-13.6) or high (OR, 8.03; 95% CI, 2.21-29.2) levels of somatoform symptom-reporting and use of antidepressants (OR, 2.54; 95% CI, 1.34-4.84) or glucocorticosteroids (OR, 6.63; 95% CI, 2.26-19.5; P ?<?.01 for all analyses) were independently associated with opioid use. Following multivariate analysis, opioid users were significantly more likely to undergo intestinal resection (hazard ratio, ?7.09; 95% CI, 1.63 to 30.9; P ?=?.009), particularly when codeine or dihydrocodeine were excluded (hazard ratio,?42.9; 95% CI, 3.36 to 548; P ?=?.004). Conclusions Opioid use in IBD is associated with psychological comorbidity and increased risk of intestinal resection, particularly in stronger formulations. Future studies should stratify the risk of individual opioids, so that robust prescribing algorithms can be developed and assess whether addressing psychological factors in routine IBD care could be an effective opioid avoidance strategy.
Journal
Inflammatory bowel diseases