The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy.

Abstract

BACKGROUND:

Suboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized.

AIMS:

Evaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatients undergoing colonoscopy.

METHODS:

Outpatients undergoing colonoscopy at a single medical centre during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score.

RESULTS:

2600 patients (57.3 ± 12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR = 1.4, 95%CI 1.0-2.1, p = 0.05) and high dose opioid users (OR = 1.7, 95%CI 1.1-2.9, p = 0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR = 1.9, 95%CI 1.1-3.0, p = 0.012), non-tricyclic antidepressants (OR = 1.5, 95%CI 1.1-2.0, p = 0.013), and antipsychotic medications (OR = 2.2, 95%CI 1.4-3.4, p = 0.001).

CONCLUSIONS:

Opiate pain medication use independently predicts inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentiates the negative impact of opiates with concurrent use.

• Authors: Vladimir M Kushnir, Pavan Bhat, Reena V Chokshi, Alexander Lee, Brian B Borg, Chandra Prakash Gyawali, Gregory S Sayuk
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 46 Issue 1 Pg. 56-61 (Jan 2014) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 24012559 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. All rights reserved.

Chemical References

• Analgesics, Opioid
• Antidepressive Agents
• Antidepressive Agents, Tricyclic
• Antipsychotic Agents
• Cathartics
• Polyethylene Glycols

Topics

• Adult
• Aged
• Ambulatory Care
• Analgesics, Opioid (adverse effects)
• Antidepressive Agents (adverse effects)
• Antidepressive Agents, Tricyclic (adverse effects)
• Antipsychotic Agents (adverse effects)
• Cathartics (therapeutic use)
• Colonoscopy
• Dose-Response Relationship, Drug
• Female
• Gastrointestinal Motility (drug effects)
• Humans
• Male
• Middle Aged
• Polyethylene Glycols (therapeutic use)
• Retrospective Studies