In the Journals

Dyssynergic defecation more common in OIC

Patients with chronic constipation who use opioids are more likely to have dyssynergic defecation and more severe symptoms of constipation than patients with chronic constipation who do not use opioids, according to study results.

“The impact of opioids on colon transit in patients with [opioid-induced constipation (OIC)] is widely recognized and mediated through a number of dierent mechanisms,” Borko Nojkov, MD, of the division of gastroenterology and hepatology at Michigan Medicine, and colleagues wrote. “However, the impact of opioids on the mechanics of defecation and rectal sensation is poorly understood but potentially relevant to the pathogenesis and treatment of OIC.”

Researchers performed a retrospective analysis of prospectively collected data comprising 3,452 patients with chronic constipation. They compared anorectal function testing (AFT) characteristics, symptom burden and quality of life between patients who were prescribed an opioid (n = 588) and those who were not (NOIC; n = 2.864).

In their assessment of AFT, investigators included variables like anal sphincter pressure and response during simulated defecation, balloon expulsion testing and rectal sensation. They defined dyssynergic defecation as an inability to relax the anal sphincter during simulated defecation and an abnormal balloon expulsion test. Patients also completed the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires.

Infographic about the incidence of dyssynergic defecation in patients with OIC.
Patients with chronic constipation who use opioids are more likely to have dyssynergic defecation and more severe symptoms of constipation than patients with chronic constipation who do not use opioids, according to study results.

Nojkov and colleagues found that patients with OIC were more likely to have dyssynergic defecation than patients with NOIC (28.6% vs. 21.4%; P < .001). They were also more likely to have abnormal simulated defecation response on anorectal manometry (59% vs. 43.8%; P < .001) and an abnormal balloon expulsion test (48% vs. 42.5%; P = .02).

Patients with OIC reported more severe symptoms of constipation (P < .02) and worse quality of life (P < .05) compared with patients with NOIC.

“These ndings provide new and important insights into the eects of opioids on anorectal function and chronically constipated patients’ illness experience,” Nojkov and colleagues wrote. “Our results should be considered preliminary and hypothesis generating but, if validated in further, prospective studies, could hold important implications for health care providers caring for chronically constipated patients taking opioids.” by Alex Young

Disclosures: The authors report no relevant financial disclosures.

Patients with chronic constipation who use opioids are more likely to have dyssynergic defecation and more severe symptoms of constipation than patients with chronic constipation who do not use opioids, according to study results.

“The impact of opioids on colon transit in patients with [opioid-induced constipation (OIC)] is widely recognized and mediated through a number of dierent mechanisms,” Borko Nojkov, MD, of the division of gastroenterology and hepatology at Michigan Medicine, and colleagues wrote. “However, the impact of opioids on the mechanics of defecation and rectal sensation is poorly understood but potentially relevant to the pathogenesis and treatment of OIC.”

Researchers performed a retrospective analysis of prospectively collected data comprising 3,452 patients with chronic constipation. They compared anorectal function testing (AFT) characteristics, symptom burden and quality of life between patients who were prescribed an opioid (n = 588) and those who were not (NOIC; n = 2.864).

In their assessment of AFT, investigators included variables like anal sphincter pressure and response during simulated defecation, balloon expulsion testing and rectal sensation. They defined dyssynergic defecation as an inability to relax the anal sphincter during simulated defecation and an abnormal balloon expulsion test. Patients also completed the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires.

Infographic about the incidence of dyssynergic defecation in patients with OIC.
Patients with chronic constipation who use opioids are more likely to have dyssynergic defecation and more severe symptoms of constipation than patients with chronic constipation who do not use opioids, according to study results.

Nojkov and colleagues found that patients with OIC were more likely to have dyssynergic defecation than patients with NOIC (28.6% vs. 21.4%; P < .001). They were also more likely to have abnormal simulated defecation response on anorectal manometry (59% vs. 43.8%; P < .001) and an abnormal balloon expulsion test (48% vs. 42.5%; P = .02).

Patients with OIC reported more severe symptoms of constipation (P < .02) and worse quality of life (P < .05) compared with patients with NOIC.

“These ndings provide new and important insights into the eects of opioids on anorectal function and chronically constipated patients’ illness experience,” Nojkov and colleagues wrote. “Our results should be considered preliminary and hypothesis generating but, if validated in further, prospective studies, could hold important implications for health care providers caring for chronically constipated patients taking opioids.” by Alex Young

Disclosures: The authors report no relevant financial disclosures.

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