Intest Res.  2020 Apr;18(2):238-244. 10.5217/ir.2019.00104.

Clinical profile and outcomes of opioid abuse gastroenteropathy: an underdiagnosed disease entity

• Mahajan R
• Gupta Y
• Singh A
• Dhiman P
• Midha V
• Kakkar C
• Narang V
• Mehta V
• Saggar K
• Sood A

• KMID: 2501389
• DOI: http://doi.org/10.5217/ir.2019.00104

Abstract

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.
Methods
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.
Results
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.
Conclusions
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.

Keyword

Opium; Opioid abuse gastroenteropathy; Ulcer; Stricture; Intestinal obstruction

Figure

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  Fig. 1. CT findings in a patient with opioid abuse gastroenteropathy. (A) Contrast-enhanced CT image showing dilated stomach secondary to narrowing and wall thickening in the D2 segment of duodenum (white arrow) in a 28-year-old patient with a history of long-term opioid abuse who presented with gastric outlet obstruction. (B) The same patient had another stricture at the junction of the D3-D4 segment (black dashed arrow) with upstream duodenal dilatation. S, stomach; D, duodenal.

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  Fig. 2. Endoscopic images of patients with opioid gastroenteropathy showing ulcerated pyloric strictures (A, B); ulcerated small bowel stricture (C); and ileocecal stricture (D).

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  Fig. 3. Histopathological findings in opioid abuse gastroenteropathy. Histopathological examination showed reactive changes of the epithelium with minimal activity, mild degree of chronic inflammatory infiltrate comprised of lymphocytes, plasma cells and few eosinophils in lamina propria and variable degree of submucosal fibrosis (H&E, ×400).

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