May 04, 2010
Doctors often unnecessarily treat irritable bowel syndrome (IBS) with narcotics, according to a study led by University of North Carolina at Chapel Hill researchers.
 
“This course of treatment is generally inadvisable because it does not improve functional status and may have adverse long term effects,” said study lead author Spencer D. Dorn, MD, MPH, assistant professor in the UNC School of Medicine. Dorn presented the findings May 3 at the annual Digestive Disease Week conference in New Orleans.

Dr. Kant Bangdiwala

Dr. Kant Bangdiwala
Dr. Spencer Dorn

Dr. Spencer Dorn

Dorn, an alumnus of the UNC Gillings School of Global Public Health, and study co-authors including Shrikant Bangdiwala, PhD, research professor of biostatistics at the UNC public health school, surveyed nearly 1,800 patients who had seen a physician and were diagnosed with IBS. They looked at demographic characteristics, clinical features including subtype, duration, severity, most troublesome symptom, quality of life, psychological factors such as anxiety and depression, overall satisfaction with care and medications currently used.

 
The study, conducted by researchers at the UNC School of Medicine’s Center for Functional GI & Motility Disorders, where Bangdiwala directs the biometry core, and the International Foundation for Functional Gastrointestinal Disorders, found that 325 patients, or 18 percent, reported currently using narcotics. These patients reported more abdominal pain, poorer health quality, more IBS-related limitations, more hospitalizations and surgeries, and that they were more likely to use antidepressants and antacid medications.
 
“Although narcotics are commonly used, they may have deleterious long term effects including narcotic bowel syndrome and sometimes drug dependency,” said Dorn. Instead, Dorn and colleagues recommend an integrative approach that emphasizes patient education, self-management over time, non-narcotic symptom-based therapies, and sometimes antidepressants and/or psychotherapy.
 
“In the current U.S. health care system, clinicians often lack the time, infrastructure, and incentives needed to provide integrative care to patients with chronic conditions, including IBS,” said Dorn.
 
“Instead, very often physicians take the path of least resistance. Narcotic prescriptions are a quick and easy way to get patients out of their office, even though the long-term effects can be harmful.” He added that physicians have to resolve to finding better training and incentives to treat patients who would otherwise benefit from more integrative treatments.
 
Dorn said the findings are especially important since the United States accounts for just 4 percent of the world’s population and more than 80 percent of the narcotics prescribed worldwide.
 
UNC co-authors of the study, in addition to Bangdiwala, were Carolyn B. Morris, Yuming J. Hu, and Douglas A. Drossman, MD, all from the division of gastroenterology and hepatology in the School of Medicine. Co-authors from the International Foundation for Functional Gastrointestinal Disorders were Nancy J. Norton and William F. Norton.

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UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.

 

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