Study reveals alarming rise in the incidence of gastric outlet obstruction due to NSAIDs and opioid abuse in North West India

Ashish Joshi, Professor, Department of Gastroenterology, Sardar Patel Medical College, Bikaner, Rajasthan, and colleagues observed an alarming rise in the incidence of GOO due to NSAIDs and opioid abuse at their centre. They stress making efforts to control the indiscriminate use of these over-the-counter drugs to prevent dreaded complications.

Gastric outlet obstruction is caused by obstruction of the pyloric channel or duodenum. It may be defined more specifically as the obstruction of the pylorus or pyloroduodenal area up to D2 (ampulla). The obstruction can be extrinsic or intrinsic to the duodenum and pylorus. The causes are mainly classified as benign or malignant.

The benign causes are corrosive ingestion, peptic ulcer disease (PUD), tuberculosis, NSAID, and opioid abuse. The most common cause of GOO in India is malignancy. PUD and corrosive ingestion are the common benign causes. NSAID intake in excessive doses or over a prolonged duration is known to cause ulceration of mucosa in the duodenum and stomach. NSAID and opioid abuse is a rare cause of GOO.

Dr. Joshi and the team conducted the study to know the incidence of nonsteroidal anti-inflammatory drugs (NSAIDs) and synthetic opioid abuse in cases of GOO.

They discussed the rising incidence of drug abuse containing synthetic opioid preparations like dextropropoxyphene or tramadol either in combination with NSAIDs like diclofenac or non-NSAID drugs like paracetamol in patients with gastric outlet obstruction.

The researchers conducted an observational study involving consecutive causes of GGO diagnosed from 2017 to 2019. A detailed history, including clinical examination and drug addiction history, was done. Investigations included routine biochemical and haematological tests, ultrasonography, upper gastrointestinal endoscopy (UGIE), rapid urease test (RUT), and histopathology of the diseased area.

Based on the study, the researchers reported the following findings:

• Among the 102 cases diagnosed with GOO, 60.78% cases had a history of drug addiction.
• The drug addiction history was as follows: NSAIDs and opioids in 56, opioids alone in four, and NSAIDs alone in two cases.
• The most common site of stricture was the second part of the duodenum.
• The features on histopathology were ulcerations of the mucosa infiltrated by eosinophils, plasma cells, and lymphocytes.

"The most common cause of GOO in our centre is NSAID and opioid addiction," the researchers wrote.

"Due to abuse of NSAIDs along with opium, opium addicts are highly prone to duodenal ulcers. So, these patients should be evaluated for duodenal ulcers at the earliest suspicion to prevent further complications."

"Legal efforts should be made to control the indiscriminate use of these over-the-counter drugs to prevent dreaded complications," they concluded.

Reference:

Joshi A, Falodia S, Vyas A, et al. Alarming Incidence of Gastric Outlet Obstruction Related to NSAIDS and Synthetic Opioid in North West India. J Assoc Physicians India 2024;72(1):14–16.