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Implications of the Opioid Epidemic for the Clinical Gastroenterology Practice

Current Gastroenterology Reports volume 21, Article number: 44 (2019) Cite this article

Abstract

Purpose of Review

The opioid epidemic in the USA has led to a rise in opioid-related gastrointestinal (GI) side effects that are often difficult to diagnose and treat. The aim of this report is to discuss opioid pathophysiology, opioid-related GI side effects, clinical presentation, and diagnostic criteria and to review the current pharmacotherapy available.

Recent Findings

Opioid-related GI disorders are increasingly recognized and include, but are not limited to, opioid-induced esophageal dysfunction (OIED), gastroparesis, opioid-induced constipation (OIC), narcotic bowel syndrome (NBS), acute post-operative ileus, and anal sphincter dysfunction. Treatment of these conditions is challenging. OIC has the most available pharmacotherapy for treatment, including classical laxatives, peripherally acting μ-receptor antagonists (PAMORAs), novel therapies (lubiprostone, prucalopride- 5-HT agonist), and preventative therapies (PR oxycodone/naloxone).

Summary

The gastrointestinal effects of opioid therapy are variable and often debilitating. While medical management for some opioid-related GI side effects exists, limiting or completely avoiding opioid use for chronic non-cancer pain will mitigate these effects most effectively.

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Affiliations

  1. Department of Medicine, Oregon Health and Science University, Portland, OR, USA

    Namisha Thapa

  2. Department of Medicine, Duke University, Durham, NC, USA

    Matthew Kappus

  3. Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Ryan Hurt

  4. Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L-461, Portland, OR, 97239, USA

    Sarah Diamond

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  1. Namisha Thapa
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Correspondence to Sarah Diamond.

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Thapa, N., Kappus, M., Hurt, R. et al. Implications of the Opioid Epidemic for the Clinical Gastroenterology Practice. Curr Gastroenterol Rep 21, 44 (2019). https://doi.org/10.1007/s11894-019-0712-7

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Keywords

  • Opioid epidemic
  • Clinical gastroenterology
  • Gastrointestinal dysmotility
  • Narcotic bowel syndrome
  • Chronic narcotics