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IntroductionNarcotic bowel syndrome (NBS) is characterised by chronic abdominal pain that worsens or fails to respond to increasing opioid doses. Limited benefit and harmful effects of long-term opiates, with resultant morbidity, mortality and healthcare use are well documented. We aimed to evaluate current UK clinical practice and services for diagnosis and management of NBS.MethodA 27 item electronic questionnaire (surveymonkey) was developed to establish clinicians’ perspectives on demographics, clinical phenotype and management of NBS patients. After a regional pilot study this was circulated nationally via the BSG.Results47 responses were received (96% gastroenterologists, 57% at teaching hospitals (TH), 30% at district general hospitals (DGH)) with almost all respondents (94%) having made a prior NBS diagnosis.DemographicsReported NBS prevalence was low (57% of clinicians with <5 cases/year). Patients were described as mostly female (76%), aged 21–40 (88%).DiagnosisThe most popular criteria used to make a NBS diagnosis were ‘chronic abdominal pain’ (91%) and ‘long term opiate use’ (91%), whereas presence of a ‘soar and crash response’ (34%) and ‘pain that is progressing over time’ (30%) were least frequently used. Only 3/47 (6%) respondents use Rome IV criteria.Management70% offer opiate withdrawal as either inpatient or outpatient. Surprisingly, only 51% prescribe non-opioid analgesia in NBS. Of these Amitriptyline (64%), Gabapentin (55%) and Pregabalin (53%) were reported to be the most useful. Clinicians at TH were more likely to prescribe non-opioid analgesia than at DGH (p=0.006). Up to 1/4 of NBS patients require nutritional support according to a majority (62%) of respondents. The most common form of nutritional support was oral (83%), then nasogastric (45%) and jejunal tube (43%). 33% had used parenteral nutrition in a NBS patient.Referral to additional services:77% refer to a chronic pain team, 36% to clinical psychology and 21% to tertiary services. In most centres (87%) there is no designated service to manage NBS and no access to clinical psychology (56%). In centres without access to NBS services, 76% believed their hospital would benefit from the development of a service.ConclusionThis survey has identified wide variation in clinical practice when diagnosing and managing NBS, and a national demand for improving and developing access to specialist services in the UK.Disclosure of InterestNone Declared |
