Laith Al Momani, MD1, Mohammad Alomari, MD2, Muhammad Talal Sarmini, MD2, Fredy Nehme, MD3, Mark Young, MD1, Carlos Romero-Marrero, MD, MSc4
1East Tennessee State University, Johnson City, TN; 2Cleveland Clinic Foundation, Cleveland, OH; 3University of Missouri, Kansas City, MO; 4Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
Introduction: Opioid and benzodiazepine use in cirrhotic patients is probably underestimated and results in a significant burden for both patients and the healthcare system. Recent epidemiologic studies reported an upward trend in the number of both prescriptions in this drug-sensitive patient population. This study therefore aimed to derive a robust prevalence estimate of chronic opioid and benzodiazepine use in patients with liver cirrhosis.
Methods: We performed a comprehensive literature search in PubMed, PubMed Central, Embase, and ScienceDirect databases from inception through May, 2019 to identify all studies that evaluated the prevalence of either chronic opioid use or benzodiazepine use in patients diagnosed with cirrhosis. We included studies that presented event rates with a 95% confidence interval (CI) or presented the data sufficient to calculate the event rate with a 95% CI. Although the definition of chronic opioid use varied between the involved studies, more than 60 days of either opioid or benzodiazepine use per annum was considered ‘chronic’ in this meta-analysis. Statistical analysis was performed using the Comprehensive Meta-Analysis (CMA), Version 3 software.
Results: Seven studies with a total of 300472 patients with liver cirrhosis were included in the analysis of chronic opioid use with a pooled event rate of 34.7% (95% CI: 0.239 – 0.473) and a reported prevalence range of 22.3-64.7% among the included studies. (Figure 1) On the other hand, six studies with a total of 173127 patients with liver cirrhosis were included in the analysis of chronic benzodiazepine use with a pooled event rate of 15.9% (95% CI: 0.079 - 0.294) and a reported prevalence range of 7.9-37.1%. (Figure 2)
Discussion: Our results indicate that chronic opioid and benzodiazepine use are prevalent among patients with liver cirrhosis. This is clinically important as their use was shown to be associated with increased readmission rates, hepatic decompensation, and all-cause mortality. Physicians should be cognizant of the implications of prescribing these medications and consider pursuing other pharmacological and non-pharmacological forms of analgesia in this patient population.
Citation: Laith Al Momani, MD; Mohammad Alomari, MD; Muhammad Talal Sarmini, MD; Fredy Nehme, MD; Mark Young, MD; Carlos Romero-Marrero, MD, MSc. P2459 - THE PREVALENCE OF CHRONIC OPIOID AND BENZODIAZEPINE USE IN PATIENTS WITH LIVER CIRRHOSIS: A META-ANALYSIS AND SYSTEMATIC REVIEW. Program No. P2459. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.