Abstract
Background
Postoperative ileus (POI) is a temporary delay of coordinated intestinal peristalsis. Alvimopan, an oral peripherally acting mu-opioid receptor antagonist approved for accelerating gastrointestinal recovery, has never been studied specifically in patients with inflammatory bowel disease (IBD).
Aim
To investigate the efficacy of alvimopan in preventing POI among IBD patients.
Methods
A retrospective chart review was conducted on 246 IBD patients undergoing bowel surgery between 2012 and 2017. Data collected included demographics, IBD subtype, length of stay (LOS), postoperative gastrointestinal symptoms, and administration of alvimopan. The primary outcome was POI; secondary gastrointestinal recovery outcomes were: time to first flatus, time to first bowel movement, time to tolerating a liquid diet, time to tolerating solid food, and LOS.
Results
When compared with the control group, patients in the alvimopan group had shorter times to tolerating liquids and solids, first flatus, and first bowel movements (p < 0.01). LOS was shorter in the alvimopan group when compared with controls (p < 0.01). The overall incidence of POI was higher in controls than in the alvimopan group (p = 0.07). For laparoscopic surgeries, the incidence of POI was also higher in controls than in the alvimopan group (p < 0.01). On multivariable analysis, alvimopan significantly decreased time to all gastrointestinal recovery endpoints when compared to controls (p < 0.01).
Conclusions
Alvimopan is effective in accelerating time to gastrointestinal recovery and reducing POI in IBD patients. While the benefits of alvimopan have been demonstrated previously, this is the first study of the efficacy of alvimopan in IBD patients.
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Abbreviations
- POI:
-
Postoperative ileus
- UC:
-
Ulcerative colitis
- CD:
-
Crohn’s disease
- IBD:
-
Inflammatory bowel disease
- IPAA:
-
Ileal pouch–anal anastomosis
- LOS:
-
Length of stay
- ERP:
-
Enhanced recovery pathway
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Janice Jang, Benjamin Kwok, Hua Zhong, Yuhe Xia, Alexis Grucela, Mitchell Bernstein, Feza Remzi, and Jingjing Chen declare no conflict of interest. David Hudesman is a consultant for Pfizer, Takeda, Jansenn Biotech, Abbvie, and Salix and receives research support from Pfizer. Shannon Chang is a consultant for Takeda, Pfizer, and Oshi Health. Jordan Axelrad is a consultant for and receives research support from BioFire.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments of comparable ethical standards. For this type of study, formal consent is not required.
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Jang, J., Kwok, B., Zhong, H. et al. Alvimopan for the Prevention of Postoperative Ileus in Inflammatory Bowel Disease Patients. Dig Dis Sci 65, 1164–1171 (2020). https://doi.org/10.1007/s10620-019-05839-5
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DOI: https://doi.org/10.1007/s10620-019-05839-5