Chronic Pancreatitis and Opioid Use Linked to Increased GI Symptoms and Complications

Patients with chronic pancreatitis (CP) who use opioids for abdominal pain have increased gastrointestinal (GI) symptoms, local pancreatic complications and associated conditions, as well as undergo more testing and require more interventions for pain management, according to research presented at Digestive Disease Week 2021.

Investigators retrospectively reviewed patients with CP who required opioids for abdominal pain from November 2018 to November 2020. Patients who had an established diagnosis of CP and were followed by the pancreas center at the authors’ institution were eligible.

Opioid use during the study period was assessed by a review of the state opioid monitoring program that tracks controlled prescriptions. The researchers then compared patient demographics, clinical features, comorbidities, outcomes, and resource use between CP patients with and without opioid use.

A total of 200 patients with CP were included: 120 patients did not use opioids for abdominal pain (mean age, 57.9 [standard deviation (SD), 17.0] years; 43.3% male; 89.1% White), and 80 did use opioids (mean age, 55.5 [SD 13.1] years; 48.8% male; 87.5% White). A significantly greater proportion of patients who actively used tobacco also used opioids (34.2% vs 20.3%, P =.02). Other characteristics that were assessed, including active alcohol use, active delta-9-tetrahydrocannabinol (THC) use, cardiac disease, and psychiatric illness, were not significant.

A significantly higher proportion of CP patients using opioids reported increased GI symptoms such as pain, nausea, and weight loss (P <.05), and a greater proportion were using pancreatic enzyme supplementation (81.4% vs 63.9%; P =.03).

Gastroparesis (50% vs 35%; P =.02) and small intestinal bacterial overgrowth (47.5% vs 24.8%; P =.04) were more common among patients using opioids than in those who did not use opioids. In addition, patients with opioid use had more local pancreatic complications including splanchnic vein thrombosis and pseudocysts (P <.05).

Participants that used opioids also underwent more imaging, especially computed tomography, than those who did not use opioids (3.34 ± 3.06 scans vs 2.13 ± 1.44 scans, respectively; P =.002), had higher rates of hospitalization for CP flares (4.19 ± 4.50 vs 1.92 ± 1.72, respectively; P <.001), had more celiac plexus blocks (30.4% vs 12.8%, respectively; P =.005), and underwent more pancreatic surgeries (22.8% vs 8.55%, respectively; P =.01) for CP-related pain.

“These results suggest that the disease course for patients on opioids may be more morbid than for those without opioids,” stated the researchers. “Prospective data are needed to validate these findings.”

Reference

Shah I, Yakah W, Ahmed A, et al. Clinical characteristics, outcomes and resource utilization in opioid-dependent chronic pancreatitis. Poster presented at: Digestive Disease Week Annual Meeting; May 21-23, 2021. Abstract Fr348.