Digestive Diseases and Sciences

, Volume 57, Issue 4, pp 994–999

Increased Sedation Requirements During Endoscopy in Patients with Celiac Disease

  • Benjamin Lebwohl
  • Benjamin Hassid
  • Steven Ludwin
  • Suzanne K. Lewis
  • Christina A. Tennyson
  • Alfred I. Neugut
  • Peter H. R. Green
Original Article

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.

Keywords

Celiac disease Gastrointestinal endoscopy Colonoscopy Conscious sedation 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Benjamin Lebwohl
    • 1
  • Benjamin Hassid
    • 1
  • Steven Ludwin
    • 1
  • Suzanne K. Lewis
    • 1
  • Christina A. Tennyson
    • 1
  • Alfred I. Neugut
    • 2
  • Peter H. R. Green
    • 1
  1. 1.The Celiac Disease Center at Columbia UniversityNew YorkUSA
  2. 2.Department of Epidemiology, Mailman School of Public HealthColumbia University Medical CenterNew YorkUSA

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