GASTROENTEROLOGY ARTICLE OF THE WEEK
January 24, 2008
Grunkemeier DM, Cassara JE, Dalton CB, Drossman DA. The narcotic bowel syndrome: Clinical features, pathophysiology and management. Clin Gastroenterol Hepatol 2007;5:1126-1139.
1. Narcotic bowel syndrome is best defined as:
a. Severe painless constipation in a patient who takes narcotics
b. Nausea, bloating and painless ileus in a patient taking narcotics
c. Increasing abdominal pain that worsens as the narcotic dose is increased
d. Intestinal pseudoobstruction in a patient taking narcotics
e. Abdominal pain that worsens as the narcotic dose wanes
2. Important components of detoxification include
a. Reduction of narcotic dose by 10% to 30% per day
b. Use of a secondary amine tricyclic anti-depressant to avoid the anti-cholinergic effects of tricyclic antidepressants.
c. Paroxetine, fluoxetine and citalopram are the preferred SSRI’s
d. Medium acting benzodiazepines should be used and weaned off once withdrawal is completed
e. Clonidine as an alpha agonist to reduce sympathetic symptoms
True or False
3. The most important clinical feature of NBS is the recognition that chronic or escalating doses of narcotics cause worsening or continued pain, rather than improvement.
4. Chronic opioid use can result in activation of the Gs protein excitatory receptors resulting in hyperalgesia.
5. The best management of NBS is to completely stop the narcotic immediately and observe the patient.
6. Low dose opioid antagonists such as naltrexone have selective inhibitory effects on the excitatory (Gs) pathway thus enhancing morphine analgesia.
7. Narcotic use to treat functional GI pain is usually associated with an increased incidence of GI complications from narcotics