Mahajan Ramit, Gupta Yogesh, Singh Arshdeep, Dhiman Pulkit, Midha Vandana, Kakkar Chandan, Narang Vikram, Mehta Varun, Saggar Kavita, Sood Ajit
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India.
Intest Res. 2020 Apr;18(2):238-244. doi: 10.5217/ir.2019.00104. Epub 2020 Feb 25.
BACKGROUND/AIMS: Opioid-induced bowel dysfunction includes nausea, vomiting, constipation and abdominal distension. We describe patients presenting with gastrointestinal (GI) ulcers and ulcerated strictures secondary to opioid abuse, an entity not well described in literature.
This retrospective observational study included patients with opioid abuse gastroenteropathy presenting to Dayanand Medical College and Hospital, Ludhiana, India between January 2013 and December 2018. Opioid abuse gastroenteropathy was defined as gastric or small bowel ulcers and ulcerated strictures in patients abusing opioids, where all other possible etiologies of GI ulcers/strictures were excluded. Clinical, biochemical, endoscopic, radiological and histological parameters as well as response to treatment were assessed.
During the study period, 20 patients (mean age, 38.5±14.2 years; 100% males) were diagnosed to have opioid induced GI ulcers and/or ulcerated strictures. The mean duration of opioid consumption was 6.2±3.4 years. The mean duration of symptoms at presentation was 222.1±392.3 days. Thirteen patients (65%) had gastroduodenal involvement, 6 (30%) had a jejunoileal disease and 1 (5%) had an ileocecal stricture. Two patients (10%) presented with upper GI bleeding, 11 (55%) had features of gastric outlet obstruction and 7 (35%) presented with small bowel obstruction. Abdominal pain and iron deficiency anemia were the most common presentations. Only 1 patient (5%) responded to proton pump inhibitors, 3 (15%) had a lasting response to endoscopic balloon dilatation, while all other (80%) required surgical intervention.
Opioid abuse gastroenteropathy presents as ulcers and ulcerated strictures which respond poorly to medical management and endoscopic balloon dilatation. A majority of these cases need surgical intervention.
背景/目的：阿片类药物引起的肠功能障碍包括恶心、呕吐、便秘和腹胀。我们描述了因阿片类药物滥用继发胃肠道（GI）溃疡和溃疡性狭窄的患者，这一情况在文献中描述较少。
这项回顾性观察性研究纳入了2013年1月至2018年12月期间在印度卢迪亚纳的达亚南德医学院和医院就诊的阿片类药物滥用性胃肠病患者。阿片类药物滥用性胃肠病定义为滥用阿片类药物的患者出现胃或小肠溃疡以及溃疡性狭窄，且排除了胃肠道溃疡/狭窄的所有其他可能病因。评估了临床、生化、内镜、放射学和组织学参数以及治疗反应。
在研究期间，20例患者（平均年龄38.5±14.2岁；100%为男性）被诊断为阿片类药物引起的胃肠道溃疡和/或溃疡性狭窄。阿片类药物使用的平均时长为6.2±3.4年。就诊时症状的平均持续时间为222.1±392.3天。13例患者（65%）有胃十二指肠受累，6例（30%）有空肠回肠疾病，1例（5%）有回盲部狭窄。2例患者（10%）出现上消化道出血，11例（55%）有胃出口梗阻特征，7例（35%）出现小肠梗阻。腹痛和缺铁性贫血是最常见的表现。只有1例患者（5%）对质子泵抑制剂有反应，3例（15%）对内镜下球囊扩张有持久反应，而所有其他患者（80%）需要手术干预。
阿片类药物滥用性胃肠病表现为溃疡和溃疡性狭窄对药物治疗和内镜下球囊扩张反应不佳。这些病例中的大多数需要手术干预。
