National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK.
Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Neurogastroenterol Motil. 2020 Jul;32(7):e13839. doi: 10.1111/nmo.13839. Epub 2020 Mar 13.
Opioid use has reached epidemic proportions. In contrast to the known effect of opioids on gut transit, the effect on rectal sensorimotor function has not been comprehensively investigated.
Cross-sectional (hypothesis-generating) study of anorectal physiology studies in 2754 adult patients referred to a tertiary unit (2004-2016) for investigation of functional constipation (defined by "derived" Rome IV core criteria). Statistical associations between opioid usage, symptoms, and anorectal physiological variables were investigated. Opioids were sub-classified as prescriptions for mild-moderate or moderate-severe pain.
A total of 2354 patients (85.5%) were classified as non-opioid users, 162 (5.9%) as opioid users for mild-moderate pain, and 238 (8.6%) for moderate-severe pain. Opioids for moderate-severe pain were associated with increased symptomatic severity (Cleveland Clinic constipation score 18.5 vs 15.1; mean difference 2.9 [95%-CI 2.3-3.6]; P < .001), rectal hyposensitivity (odds ratio 1.74 [95%-CI 1.23-2.46]; P = .002), functional evacuation disorders (odds ratio 1.73 [95%-CI 1.28-2.34]; P < .001), and delayed whole-gut transit (odds ratio 1.68 [95%-CI 1.19-2.37]; P = .003). Differences in anorectal variables between opioid users for mild-moderate pain and non-opioid users were not statistically significant. Hierarchical opioid use (non vs mild-moderate vs moderate-severe) was associated with decreasing proportions of patients with no physiological abnormality on testing (40.2% vs 38.1% vs 29.2%) and increasing proportions with both delayed whole-gut transit and rectal sensorimotor dysfunction (16.6% vs 17.5% vs 28.5%).
Opioid use is over-represented in patients referred for investigation of constipation. Opioids for moderate-severe pain are associated with rectal sensorimotor abnormalities. Further studies are required to determine whether this association indicates causation.
阿片类药物的使用已经达到了流行的程度。与已知的阿片类药物对肠道转运的影响相比，其对直肠感觉运动功能的影响尚未得到全面研究。
对 2754 名因功能性便秘（通过“衍生的”罗马 IV 核心标准定义）而被转诊至三级单位进行检查的成年患者的直肠生理研究进行了横断面（假设生成）研究。研究了阿片类药物使用、症状和直肠生理变量之间的统计学关联。将阿片类药物分为轻度至中度疼痛和中度至重度疼痛的处方。
共有 2354 名患者（85.5%）被归类为非阿片类药物使用者，162 名（5.9%）为轻度至中度疼痛的阿片类药物使用者，238 名（8.6%）为中度至重度疼痛的阿片类药物使用者。中重度疼痛的阿片类药物与症状严重程度增加（克利夫兰诊所便秘评分 18.5 与 15.1；平均差异 2.9 [95%-CI 2.3-3.6]；P<0.001）、直肠低敏性（比值比 1.74 [95%-CI 1.23-2.46]；P=0.002）、功能性排空障碍（比值比 1.73 [95%-CI 1.28-2.34]；P<0.001）和全胃肠道转运延迟（比值比 1.68 [95%-CI 1.19-2.37]；P=0.003）相关。轻度至中度疼痛的阿片类药物使用者和非阿片类药物使用者之间的直肠变量差异无统计学意义。按等级使用阿片类药物（非、轻度至中度、中重度）与检测中无生理异常的患者比例逐渐降低（40.2%、38.1%、29.2%）和同时存在全胃肠道转运延迟和直肠感觉运动功能障碍的患者比例增加（16.6%、17.5%、28.5%）相关。
阿片类药物在因便秘就诊的患者中过度使用。中重度疼痛的阿片类药物与直肠感觉运动异常有关。需要进一步研究以确定这种关联是否表明因果关系。
