OC-050 A national survey on prevalence, diagnosis, management and service provision for narcotic bowel syndromein the u.k
IntroductionNarcotic bowel syndrome (NBS) is characterised by chronic abdominal pain that worsens or fails to respond to increasing opioid doses. Limited benefit and harmful effects of long-term opiates, with resultant morbidity, mortality and healthcare use are well documented. We aimed to evaluate...
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| Veröffentlicht in: | Gut 2017-07, Vol.66 (Suppl 2), p.A26 |
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| creator | Kilgallon, E Vasant, DH Shields, PL Paine, PA |
| description | IntroductionNarcotic bowel syndrome (NBS) is characterised by chronic abdominal pain that worsens or fails to respond to increasing opioid doses. Limited benefit and harmful effects of long-term opiates, with resultant morbidity, mortality and healthcare use are well documented. We aimed to evaluate current UK clinical practice and services for diagnosis and management of NBS.MethodA 27 item electronic questionnaire (surveymonkey) was developed to establish clinicians’ perspectives on demographics, clinical phenotype and management of NBS patients. After a regional pilot study this was circulated nationally via the BSG.Results47 responses were received (96% gastroenterologists, 57% at teaching hospitals (TH), 30% at district general hospitals (DGH)) with almost all respondents (94%) having made a prior NBS diagnosis.DemographicsReported NBS prevalence was low (57% of clinicians with |
| doi_str_mv | 10.1136/gutjnl-2017-314472.50 |
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Limited benefit and harmful effects of long-term opiates, with resultant morbidity, mortality and healthcare use are well documented. We aimed to evaluate current UK clinical practice and services for diagnosis and management of NBS.MethodA 27 item electronic questionnaire (surveymonkey) was developed to establish clinicians’ perspectives on demographics, clinical phenotype and management of NBS patients. After a regional pilot study this was circulated nationally via the BSG.Results47 responses were received (96% gastroenterologists, 57% at teaching hospitals (TH), 30% at district general hospitals (DGH)) with almost all respondents (94%) having made a prior NBS diagnosis.DemographicsReported NBS prevalence was low (57% of clinicians with <5 cases/year). Patients were described as mostly female (76%), aged 21–40 (88%).DiagnosisThe most popular criteria used to make a NBS diagnosis were ‘chronic abdominal pain’ (91%) and ‘long term opiate use’ (91%), whereas presence of a ‘soar and crash response’ (34%) and ‘pain that is progressing over time’ (30%) were least frequently used. Only 3/47 (6%) respondents use Rome IV criteria.Management70% offer opiate withdrawal as either inpatient or outpatient. Surprisingly, only 51% prescribe non-opioid analgesia in NBS. Of these Amitriptyline (64%), Gabapentin (55%) and Pregabalin (53%) were reported to be the most useful. Clinicians at TH were more likely to prescribe non-opioid analgesia than at DGH (p=0.006). Up to 1/4 of NBS patients require nutritional support according to a majority (62%) of respondents. The most common form of nutritional support was oral (83%), then nasogastric (45%) and jejunal tube (43%). 33% had used parenteral nutrition in a NBS patient. Referral to additional services: 77% refer to a chronic pain team, 36% to clinical psychology and 21% to tertiary services. In most centres (87%) there is no designated service to manage NBS and no access to clinical psychology (56%). In centres without access to NBS services, 76% believed their hospital would benefit from the development of a service.ConclusionThis survey has identified wide variation in clinical practice when diagnosing and managing NBS, and a national demand for improving and developing access to specialist services in the UK.Disclosure of InterestNone Declared</description><identifier>ISSN: 0017-5749</identifier><identifier>EISSN: 1468-3288</identifier><identifier>DOI: 10.1136/gutjnl-2017-314472.50</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><subject>Amitriptyline ; Analgesia ; Clinical medicine ; Clinical psychology ; Demography ; Diagnosis ; Gabapentin ; Hospitals ; Intestine ; Management ; Medical diagnosis ; Morbidity ; Narcotics ; Opioids ; Pain ; Pain perception ; Parenteral nutrition ; Phenotypes ; Withdrawal</subject><ispartof>Gut, 2017-07, Vol.66 (Suppl 2), p.A26</ispartof><rights>2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2017 © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Kilgallon, E</creatorcontrib><creatorcontrib>Vasant, DH</creatorcontrib><creatorcontrib>Shields, PL</creatorcontrib><creatorcontrib>Paine, PA</creatorcontrib><title>OC-050 A national survey on prevalence, diagnosis, management and service provision for narcotic bowel syndromein the u.k</title><title>Gut</title><description>IntroductionNarcotic bowel syndrome (NBS) is characterised by chronic abdominal pain that worsens or fails to respond to increasing opioid doses. Limited benefit and harmful effects of long-term opiates, with resultant morbidity, mortality and healthcare use are well documented. We aimed to evaluate current UK clinical practice and services for diagnosis and management of NBS.MethodA 27 item electronic questionnaire (surveymonkey) was developed to establish clinicians’ perspectives on demographics, clinical phenotype and management of NBS patients. After a regional pilot study this was circulated nationally via the BSG.Results47 responses were received (96% gastroenterologists, 57% at teaching hospitals (TH), 30% at district general hospitals (DGH)) with almost all respondents (94%) having made a prior NBS diagnosis.DemographicsReported NBS prevalence was low (57% of clinicians with <5 cases/year). Patients were described as mostly female (76%), aged 21–40 (88%).DiagnosisThe most popular criteria used to make a NBS diagnosis were ‘chronic abdominal pain’ (91%) and ‘long term opiate use’ (91%), whereas presence of a ‘soar and crash response’ (34%) and ‘pain that is progressing over time’ (30%) were least frequently used. Only 3/47 (6%) respondents use Rome IV criteria.Management70% offer opiate withdrawal as either inpatient or outpatient. Surprisingly, only 51% prescribe non-opioid analgesia in NBS. Of these Amitriptyline (64%), Gabapentin (55%) and Pregabalin (53%) were reported to be the most useful. Clinicians at TH were more likely to prescribe non-opioid analgesia than at DGH (p=0.006). Up to 1/4 of NBS patients require nutritional support according to a majority (62%) of respondents. The most common form of nutritional support was oral (83%), then nasogastric (45%) and jejunal tube (43%). 33% had used parenteral nutrition in a NBS patient. Referral to additional services: 77% refer to a chronic pain team, 36% to clinical psychology and 21% to tertiary services. In most centres (87%) there is no designated service to manage NBS and no access to clinical psychology (56%). In centres without access to NBS services, 76% believed their hospital would benefit from the development of a service.ConclusionThis survey has identified wide variation in clinical practice when diagnosing and managing NBS, and a national demand for improving and developing access to specialist services in the UK.Disclosure of InterestNone Declared</description><subject>Amitriptyline</subject><subject>Analgesia</subject><subject>Clinical medicine</subject><subject>Clinical psychology</subject><subject>Demography</subject><subject>Diagnosis</subject><subject>Gabapentin</subject><subject>Hospitals</subject><subject>Intestine</subject><subject>Management</subject><subject>Medical diagnosis</subject><subject>Morbidity</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Pain</subject><subject>Pain perception</subject><subject>Parenteral nutrition</subject><subject>Phenotypes</subject><subject>Withdrawal</subject><issn>0017-5749</issn><issn>1468-3288</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNotkD1PwzAQQC0EEqXwE5AssTblHDuJPVYVXxJSl-6Wk1xKQmMXOwmqWFj4o_wSUoXphnt6unuE3DJYMsbT-13fNXYfxcCyiDMhsniZwBmZMZHKiMdSnpMZnJZJJtQluQqhAQApFZuRr806ggR-v39W1Jqudtbsaej9gEfqLD14HMwebYELWtZmZ12ow4K2xpodtmg7amxJA_qhLnCk3VCH0UEr50edL1xXFzR3nzhKj7b0rsXa0u4Nab98vyYXldkHvPmfc7J9fNiun6PXzdPLevUa5amSkYASVa4KkytTqSJPhSxZIjjyvEpkJVWSVFmVqarEkoMRyECZIlcC08IwDnxO7ibteN5Hj6HTjev9-GfQTDHIWJylcqRgovK20Qdft8YfNQN9KqynwvpUWE-FdQL8D0Vvcxo</recordid><startdate>201707</startdate><enddate>201707</enddate><creator>Kilgallon, E</creator><creator>Vasant, DH</creator><creator>Shields, PL</creator><creator>Paine, PA</creator><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>201707</creationdate><title>OC-050 A national survey on prevalence, diagnosis, management and service provision for narcotic bowel syndromein the u.k</title><author>Kilgallon, E ; Vasant, DH ; Shields, PL ; Paine, PA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b698-40de9b9cab9af9cb648d1543e3bf58f8955f7f79fded30a4e109acb94e6ca1303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Amitriptyline</topic><topic>Analgesia</topic><topic>Clinical medicine</topic><topic>Clinical psychology</topic><topic>Demography</topic><topic>Diagnosis</topic><topic>Gabapentin</topic><topic>Hospitals</topic><topic>Intestine</topic><topic>Management</topic><topic>Medical diagnosis</topic><topic>Morbidity</topic><topic>Narcotics</topic><topic>Opioids</topic><topic>Pain</topic><topic>Pain perception</topic><topic>Parenteral nutrition</topic><topic>Phenotypes</topic><topic>Withdrawal</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kilgallon, E</creatorcontrib><creatorcontrib>Vasant, DH</creatorcontrib><creatorcontrib>Shields, PL</creatorcontrib><creatorcontrib>Paine, PA</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Gut</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kilgallon, E</au><au>Vasant, DH</au><au>Shields, PL</au><au>Paine, PA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>OC-050 A national survey on prevalence, diagnosis, management and service provision for narcotic bowel syndromein the u.k</atitle><jtitle>Gut</jtitle><date>2017-07</date><risdate>2017</risdate><volume>66</volume><issue>Suppl 2</issue><spage>A26</spage><pages>A26-</pages><issn>0017-5749</issn><eissn>1468-3288</eissn><abstract>IntroductionNarcotic bowel syndrome (NBS) is characterised by chronic abdominal pain that worsens or fails to respond to increasing opioid doses. Limited benefit and harmful effects of long-term opiates, with resultant morbidity, mortality and healthcare use are well documented. We aimed to evaluate current UK clinical practice and services for diagnosis and management of NBS.MethodA 27 item electronic questionnaire (surveymonkey) was developed to establish clinicians’ perspectives on demographics, clinical phenotype and management of NBS patients. After a regional pilot study this was circulated nationally via the BSG.Results47 responses were received (96% gastroenterologists, 57% at teaching hospitals (TH), 30% at district general hospitals (DGH)) with almost all respondents (94%) having made a prior NBS diagnosis.DemographicsReported NBS prevalence was low (57% of clinicians with <5 cases/year). Patients were described as mostly female (76%), aged 21–40 (88%).DiagnosisThe most popular criteria used to make a NBS diagnosis were ‘chronic abdominal pain’ (91%) and ‘long term opiate use’ (91%), whereas presence of a ‘soar and crash response’ (34%) and ‘pain that is progressing over time’ (30%) were least frequently used. Only 3/47 (6%) respondents use Rome IV criteria.Management70% offer opiate withdrawal as either inpatient or outpatient. Surprisingly, only 51% prescribe non-opioid analgesia in NBS. Of these Amitriptyline (64%), Gabapentin (55%) and Pregabalin (53%) were reported to be the most useful. Clinicians at TH were more likely to prescribe non-opioid analgesia than at DGH (p=0.006). Up to 1/4 of NBS patients require nutritional support according to a majority (62%) of respondents. The most common form of nutritional support was oral (83%), then nasogastric (45%) and jejunal tube (43%). 33% had used parenteral nutrition in a NBS patient. Referral to additional services: 77% refer to a chronic pain team, 36% to clinical psychology and 21% to tertiary services. In most centres (87%) there is no designated service to manage NBS and no access to clinical psychology (56%). In centres without access to NBS services, 76% believed their hospital would benefit from the development of a service.ConclusionThis survey has identified wide variation in clinical practice when diagnosing and managing NBS, and a national demand for improving and developing access to specialist services in the UK.Disclosure of InterestNone Declared</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/gutjnl-2017-314472.50</doi></addata></record> |
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| subjects | Amitriptyline Analgesia Clinical medicine Clinical psychology Demography Diagnosis Gabapentin Hospitals Intestine Management Medical diagnosis Morbidity Narcotics Opioids Pain Pain perception Parenteral nutrition Phenotypes Withdrawal |
| title | OC-050 A national survey on prevalence, diagnosis, management and service provision for narcotic bowel syndromein the u.k |
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