Is Dyssynergic Defecation an Unrecognized Cause of Chronic Constipation in Patients Using Opioids?
| Autor: | Stacy B. Menees, Shanti Eswaran, Jason Baker, Richard J. Saad, Kristen Collins, Moira Armstrong, Lydia Watts, William D. Chey, Kimberly Harer, Borko Nojkov, Allen Lee, Mackenzie Thibault |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Constipation Manometry Colonic Diseases Functional Gastroenterology Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Quality of life Cost of Illness Internal medicine Severity of illness medicine Humans Defecation Chronic constipation Hepatology business.industry Anorectal manometry Middle Aged Analgesics Opioid Rectal Diseases Opioid 030220 oncology & carcinogenesis Cohort Chronic Disease Quality of Life 030211 gastroenterology & hepatology Ataxia Female medicine.symptom business medicine.drug |
| Zdroj: | The American journal of gastroenterology. 114(11) |
| ISSN: | 1572-0241 |
| Popis: | OBJECTIVES The impact of opioids on anorectal function is poorly understood but potentially relevant to the pathogenesis of opioid-induced constipation (OIC). To evaluate anorectal function testing (AFT) characteristics, symptom burden, and quality of life in chronically constipated patients prescribed an opioid (OIC) in comparison with constipated patients who are not on an opioid (NOIC). METHODS Retrospective analysis of prospectively collected data on 3,452 (OIC = 588 and NOIC = 2,864) chronically constipated patients (Rome 3) who completed AFT. AFT variables included anal sphincter pressure and response during simulated defecation, balloon expulsion test (BET), and rectal sensation. Dyssynergic defecation (DD) was defined as an inability to relax the anal sphincter during simulated defecation and an abnormal BET. Patients completed Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires. RESULTS The mean age of the study cohort was 49 years. Most patients were women (82%) and whites (83%). Patients with OIC were older than NOIC patients (50.7 vs 48.3, P = 0.001). OIC patients were significantly more likely to have DD (28.6% vs 21.4%, P < 0.001), an abnormal simulated defecation response on anorectal manometry (59% vs 43.8%, P < 0.001), and an abnormal BET (48% vs 42.5%, P = 0.02) than NOIC patients. OIC patients reported more severe constipation symptoms (P < 0.02) and worse quality of life (P < 0.05) than NOIC patients. DISCUSSION Chronically constipated patients who use opioids are more likely to have DD and more severe constipation symptoms than NOIC. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|