Impact of Opioid Use on the Natural History of Inflammatory Bowel Disease: Prospective Longitudinal Follow-up Study

Christy Riggott; Keeley M Fairbrass; Christian P Selinger; David J Gracie; Alexander C Ford

doi:10.1093/ibd/izad256

Impact of Opioid Use on the Natural History of Inflammatory Bowel Disease: Prospective Longitudinal Follow-up Study

Inflamm Bowel Dis. 2023 Oct 31:izad256. doi: 10.1093/ibd/izad256. Online ahead of print.

Authors

Christy Riggott^{1

2}, Keeley M Fairbrass^{1

2}, Christian P Selinger^{1

2}, David J Gracie^{1

2}, Alexander C Ford^{1

2}

Affiliations

¹ Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
² Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.

PMID: 37929997
DOI: 10.1093/ibd/izad256

Abstract

Background: Opioid use is increasingly prevalent amongst patients with inflammatory bowel disease (IBD), but whether opioids have deleterious effects, or their use is merely linked with more severe disease, is unclear. We conducted a longitudinal follow-up study examining this issue.

Methods: Data on demographics, gastrointestinal and psychological symptoms, quality of life, and opioid use were recorded at baseline. Data on healthcare use and adverse disease outcomes were obtained from a review of electronic medical records at 12 months. Characteristics at baseline of those using opioids and those who were not were compared, in addition to occurrence of flare, prescription of glucocorticosteroids, treatment escalation, hospitalization, or intestinal resection during the 12 months of follow-up.

Results: Of 1029 eligible participants, 116 (11.3%) were taking opioids at baseline. Medium (odds ratio [OR], 4.67; 95% confidence interval [CI], 1.61-13.6) or high (OR, 8.03; 95% CI, 2.21-29.2) levels of somatoform symptom-reporting and use of antidepressants (OR, 2.54; 95% CI, 1.34-4.84) or glucocorticosteroids (OR, 6.63; 95% CI, 2.26-19.5; P < .01 for all analyses) were independently associated with opioid use. Following multivariate analysis, opioid users were significantly more likely to undergo intestinal resection (hazard ratio, 7.09; 95% CI, 1.63 to 30.9; P = .009), particularly when codeine or dihydrocodeine were excluded (hazard ratio, 42.9; 95% CI, 3.36 to 548; P = .004).

Conclusions: Opioid use in IBD is associated with psychological comorbidity and increased risk of intestinal resection, particularly in stronger formulations. Future studies should stratify the risk of individual opioids, so that robust prescribing algorithms can be developed and assess whether addressing psychological factors in routine IBD care could be an effective opioid avoidance strategy.

Keywords: inflammatory bowel disease; opioids; prognosis.

Plain language summary

Of the 1029 patients with IBD in this study, opioid use exceeded 10% and was associated with psychological comorbidity and an increased risk of intestinal resection during longitudinal follow-up, particularly when more potent formulations were used.