P48 Opioid use is associated with intestinal resection in inflammatory bowel disease

Introduction

Despite established gastrointestinal side effects, opioid use has increased considerably among patients with inflammatory bowel disease (IBD) over the last decade.¹ Research suggests that their use in IBD is associated with increased healthcare utilization, and mortality. However, their effects on other disease outcomes are less consistent.² To evaluate this, we conducted a longitudinal follow-up study in an IBD cohort.

Methods

Participants aged ≥18 years with Crohn’s disease, ulcerative colitis, or IBD unclassified were recruited by postal invitation between 2017 and 2020 at a tertiary centre. We collected demographic data, disease activity, psychological health, and quality of life scores, and medication use at baseline. Medical records were reviewed at 12 months to identify adverse disease outcomes, including flare, glucocorticosteroid prescription, treatment escalation, hospitalisation, intestinal resection, or death.

Results

Baseline data was provided by 1029 participants (mean age 52.6 years, 54.7% female), of which 116 (11.3%) were opioid users. Opioid use at baseline was independently associated with medium (odds ratio (OR) = 4.67; 95% confidence interval (CI) 1.61–13.6, p=0.005) or high (OR = 8.03; 95% CI 2.21–29.2, p=0.002) levels of somatoform symptom-reporting, concurrent use of antidepressants (OR = 2.54; 95% CI 1.34–4.84, p=0.004) or glucocorticosteroids (OR = 6.63; 95% CI 2.26–19.5, p=0.001). During follow-up, opioid use was associated with intestinal resection (hazard ratio (HR) = 7.25; 95% CI 1.72–30.5, p=0.007) on multivariate analysis. When excluding codeine and dihydrocodeine, this association increased (HR = 36.5; 95% CI 3.07–434.8, p=0.004), and there was a trend towards opioid users being more likely to undergo one or more of hospitalisation, intestinal resection, or death (HR = 4.62; 95% CI 1.28–16.7, p=0.02)

Conclusions

Opioid use is associated with higher levels of psychological co-morbidity in IBD, highlighting the importance of addressing psychological factors in routine IBD care,² but was also independently associated with intestinal resection. This was particularly the case for more potent forms, suggesting additional caution is required regarding their use in IBD.

References

Burr NE, Smith C, West R, et al. Increasing prescription of opiates and mortality in patients with inflammatory bowel diseases in England. Clin Gastroenterol Hepatol 2018;16:534–541. Niccum B, Moninuola O, Miller K, et al. Opioid use among patients with inflammatory bowel disease: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2021;19:895–907.