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Increased Sedation Requirements During Endoscopy in Patients with Celiac Disease

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Abstract

Background

Celiac disease (CD) is associated with increased rates of neuropsychiatric disease and irritable bowel syndrome, and patients may exhibit visceral hypersensitivity.

Aim

The purpose of this study was to determine whether patients with CD have increased sedation requirements during endoscopic procedures.

Methods

In this retrospective cohort study, we identified CD patients undergoing either a colonoscopy or esophagogastroduodenoscopy (EGD), but not a dual procedure. CD patients were matched with control patients according to age, gender and endoscopist. For sedation requirements we defined “high” as falling outside of the 75th percentile of the entire cohort.

Results

In the colonoscopy analysis we identified 113 CD patients and 278 controls. In the CD group, 29 individuals (26%) required high amounts of both opioids and midazolam, as compared to 46 (17%) controls (P = 0.05). Differences were similar when considering only opioids (P = 0.06) and midazolam (P = 0.06). In the EGD analysis we identified 314 CD patients and 314 controls who met the inclusion criteria. Among the CD patients, 70 (22%) required high amounts of both opioids and midazolam compared to 51 (16%) controls (P = 0.05). Differences were similar when considering only opioids (P = 0.06) and midazolam (P = 0.04).

Conclusions

Patients with CD require higher doses of sedation during upper and lower endoscopy compared to age and gender-matched controls. Putative explanations, such as visceral hypersensitivity, chronic opioid/anxiolytic use, or underlying neuropsychiatric illness, should be evaluated prospectively.

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Conflict of interest

Dr. Green is a consultant for Shire and Alba Therapeutics, and is on the Scientific Advisory Board of Alvine Pharmaceuticals.

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Authors and Affiliations

  1. The Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, USA

    Benjamin Lebwohl, Benjamin Hassid, Steven Ludwin, Suzanne K. Lewis, Christina A. Tennyson & Peter H. R. Green

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, Room R7-725, 722 West 168th St., New York, NY, 10032, USA

    Alfred I. Neugut

Authors
  1. Benjamin Lebwohl
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  2. Benjamin Hassid
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  3. Steven Ludwin
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  4. Suzanne K. Lewis
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  5. Christina A. Tennyson
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  6. Alfred I. Neugut
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  7. Peter H. R. Green
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Corresponding author

Correspondence to Benjamin Lebwohl.

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Lebwohl, B., Hassid, B., Ludwin, S. et al. Increased Sedation Requirements During Endoscopy in Patients with Celiac Disease. Dig Dis Sci 57, 994–999 (2012). https://doi.org/10.1007/s10620-011-1959-5

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  • DOI: https://doi.org/10.1007/s10620-011-1959-5

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