Waseem Amjad, MD1, Adnan Malik, MD2, Joseph J. Alukal, MD3, Asha Pandu, MD, MCPS1, Eesha Gul, MBBS4, Muhammad Shabbir, MD1, Asra Batool, MD1 1Albany Medical Center, Albany, NY; 2Loyola University Medical Center, Maywood, IL; 3Valley Health System, Las Vegas, NV; 4King Edward Medical University, Albany, NY
Introduction: Chronic opiate use can have detrimental effect on gastrointestinal tract and can increase mortality and morbidity. We aimed to study the effect of chronic opiate use in gastroparesis population and outcomes
Methods: We performed retrospective review of the patients diagnosed with diabetic gastroparesis between September 30th, 2009 and January 31st, 2020. The 99mTc sulfur labeled food study was used to diagnose gastroparesis. Chronic opiate use was defined as use of the opium derivatives for more than 6 months before diagnosis of gastroparesis. Logistic regression was used to determine the outcomes of chronic opiate use in this population
Results: There were 322 gastroparesis patients during the study period. Of these 132 (41%) were using opiates chronically. These patients were elder (50.2 ± 15.2 vs. 45.5 ± 17.0) as compared to patients without opiate use. The gastroparesis with chronic opiate had higher prevalence of obesity (52.3% vs. 36.3%), type 2 diabetes mellitus (37.9% vs. 23.7%), chronic kidney disease (22.7% vs. 15.3%), autoimmune disease (14.4% vs. 7.4%), history of bariatric surgery (16.7% vs. 3.7%), iron (59.1% vs. 44.2%), vitamin B12 (18.9 vs. 7.9%) and vitamin D deficiencies (62.1% vs. 40%). Abdominal pain was more commonly seen among opiate users (69.7 vs. 58.4%, p=0.04). The chronic opiate in gastroparesis was associated with increased tube feeding (OR: 6.60, 95% CI 2.62-16.63, p< 0.001) and hospitalization (OR: 2.23, 95% CI 1.28-3.89, p=0.004). The opiate use in diabetic gastroparesis was associated with higher mortality (OR: 5.47, 95% CI: 1.10-21.16, p=0.04) and protein calorie malnutrition (OR: 3.74, 95% CI: 1.03-13.64, p=0.04).
Discussion: Chronic opiate use was commonly seen in gastroparesis patients. These patients required more hospitalization and tube feeding. The opiate use in diabetes gastroparesis was associated with increased protein calorie malnutrition and higher mortality.
Variables
Total cases (n=322)
Opiate use (n=132)
No opiate use (n=190)
Two group comparison (p-value)
Demographics
Age
47.4 ± 16.4
50.2 ± 15.2
45.5 ± 17.0
0.009
Female
226 (70.2)
97 (73.5)
129 (67.9)
0.28
White
231 (71.7)
94 (71.2)
137 (72.1)
0.75
Comorbidities
BMI
29.2 ± 8.6
30.5 ± 8.9
28.3 ± 8.4
0.02
Hemoglobin A1c (%)
8.3 ± 2.2
8.1 ± 2.2
8.4 ± 2.3
0.50
Obesity
138 (42.9)
69 (52.3)
69 (36.3)
0.004
HTN
127 (39.4)
59 (44.7)
68 (35.8)
0.11
T1DM
36 (11.2)
11 (8.3)
25 (13.2)
0.18
T2DM
95 (29.5)
50 (37.9)
45 (23.7)
0.006
GERD
205 (63.7)
88 (66.7)
117 (61.6)
0.35
CKD
59 (18.3)
30 (22.7)
29 (15.3)
0.002
CAD
49 (15.2)
21 (15.9)
28 (14.7)
0.77
COPD
43 (13.4)
21 (15.9)
22 (11.6)
0.26
Autoimmune
33 (10.2)
19 (14.4)
14 (7.4)
0.04
Neuromuscular dx
25 (7.8)
12 (9.1)
13 (6.8)
0.34
Cancer
33 (10.2)
15 (11.4)
18 (9.4)
0.74
Cirrhosis
7 (2.2)
4 (3.0)
3 (1.6)
0.38
Smoking
179 (55.6)
79 (59.8)
100 (52.6)
0.2
Bariatric surgery
29 (9.0)
22 (16.7)
7 (3.7)
< 0.001
Vitamin B12 deficiency
40 (12.4)
25 (18.9)
15 (7.9)
0.003
Vitamin D deficiency
158 (49.1)
82 (62.1)
76 (40)
0.002
Iron deficiency
162 (50.3)
78 (59.1)
84 (44.2)
0.01
Symptoms
Nausea
224 (69.6)
91 (68.9)
133 (70%)
0.84
Vomiting
184 (57.1)
67 (50.8)
117 (61.6)
0.05
Abdominal pain
203 (63.0)
92 (69.7)
111 (58.4)
0.04
Bloating
84 (26.1)
41 (31.1)
43 (22.6)
0.09
Post-prandial fullness/ early satiety
124 (38.5)
50 (37.9)
74 (38.9)
0.85
Constipation
64 (19.9)
31 (23.5)
33 (17.4)
0.18
Diarrhea
41 (12.7)
17 (12.9)
24 (12.6)
0.95
Weight loss
60 (18.6)
26 (19.7)
34 (17.9)
0.68
Medications
Benzodiazepines
111 (34.6)
58 (43.9)
53 (27.9)
0.002
Antidepressants
194 (60.2)
87 (65.9)
107 (56.3)
0.08
PPI
258 (80.1)
109 (82.6)
149 (78.4)
0.41
H2RA
76 (23.6)
35 (26.5)
41 (21.6)
0.31
Treatment
Prokinetics
168 (52.2)
72 (54.5)
96 (50.5)
0.48
Tube feeding
37 (11.5)
26 (19.7)
11 (5.8)
< 0.001
Nutrition evaluation
62 (19.3)
30 (22.7)
32 (16.8)
Table: Baseline characteristic of gastroparesis use with history of opiate use.
Disclosures: Waseem Amjad indicated no relevant financial relationships. Adnan Malik indicated no relevant financial relationships. Joseph Alukal indicated no relevant financial relationships. Asha Pandu indicated no relevant financial relationships. Eesha Gul indicated no relevant financial relationships. Muhammad Shabbir indicated no relevant financial relationships. Asra Batool indicated no relevant financial relationships.
Waseem Amjad, MD1, Adnan Malik, MD2, Joseph J. Alukal, MD3, Asha Pandu, MD, MCPS1, Eesha Gul, MBBS4, Muhammad Shabbir, MD1, Asra Batool, MD1. P0987 - Chronic Opiate Use in Diabetic Gastroparesis Is Associated With Malnutrition and Increased Mortality, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
