Peptic ulcer characteristics in oral opium and non-opium user patients with upper gastrointestinal bleeding

BACKGROUND/AIMS

Upper gastrointestinal bleeding (UGIB) is a frequent medical issue. The primary risk factors for bleeding peptic ulcers are Helicobacter pylori infection and non-steroidal anti-inflammatory drugs. The association between acute gastric/duodenal ulcer and opium use has been previously proposed; however, there is no available data on endoscopic findings of patients with acute UGIB who use opium.

MATERIALS AND METHODS

In the present descriptive cross-sectional study, endoscopic data of 50 consecutive patients with oral opium use and 50 consecutive patients without any opium use who were admitted for UGIB were recorded. The size (5-10 mm, 11-20 mm, or more than 20 mm), number (single, double, or multiple), and location of the ulcers (esophagus, gastric corpus including the fundus and body, antrum, angulus, or duodenum) were examined by endoscopy in both groups.

RESULTS

Three or more ulcers were observed in 46% and 16% of patients with oral opium use and without opium use, respectively (P-value = 0.001). The rate of giant ulcers (> 20 mm) was significantly higher in patients who used oral opium (40% vs. 12%; P-value = 0.007). Esophageal ulcers were also more common in oral opium users (30%) than non-users (8%) with UGIB (P-value = 0.01). Nevertheless, the location of the ulcers between the two groups generally was not statistically different.

CONCLUSIONS

This study has demonstrated that multiple, large peptic ulcers in GIB are potential complications of oral opium use. This could aid the needed modifications in the treatment protocol for these patients.

Thyroid function and opium use disorder: a cross-sectional study on the Fasa adults cohort study (FACS), 2017

BACKGROUND

Addiction increases the risk of different lifelong disorders. However, there are limited studies evaluating the effects of opioid use disorder (OUD) on thyroid function. The present study aimed to compare the thyroid function of individuals with and without OUD.

METHODS

This cross-sectional study was conducted on 700 eligible participants of the Persian Cohort of Fasa, Iran. Pregnant women and participants with false or missing data were excluded from the study. Remained participants were divided into case and control groups based on the recorded history of OUD. Frozen plasma samples of the cohort bank were used to determine the levels of T3, T4, and thyroid-stimulating hormone (TSH). The thyroid function was compared between the two groups using the Mann-Whitney test (P < 0.05).

RESULTS

The mean age of the final studied population (n = 648) was 54.0 ± 9.8 years, including 336 men (49.1%) and 197 participants with OUD (28.8%). The median levels of TSH, T4, and T3 were 2.91 ± 4.61, 9.26 ± 3.65, and 1.22 ± 0.49, respectively. The case group had significantly higher TSH (3.72 ± 6.2 vs. 2.58 ± 3.75, P < 0.001) and lower T4 (8 ± 3.6 vs. 9.8 ± 3.5, P < 0.001). Also, T3 was slightly lower in the case group (1.1 ± 0.5 vs. 1.3 ± 0.5; P = 0.369), although this association was only significant in female opium users (P < 0.001).

CONCLUSIONS

The present findings revealed that OUD caused a reduction in T4 while increasing TSH. Therefore, OUD may lead to the development of primary hypothyroidism, which needs to be investigated in future studies.

Evaluation of the prevalence of asthma and chronic obstructive pulmonary disease among opium users, and cigarette smokers and comparison with normal population in Kharameh: a cross-sectional study

BACKGROUND

Recent studies have suggested that opium use may increase mortality from pulmonary diseases. However, there are limited comprehensive studies regarding the prevalence of Asthma and Chronic Obstructive Pulmonary Disease (COPD) among tobacco and opium users has been published. We aimed to determine the prevalence of respiratory disease among tobacco and opium users.

METHODS

This cross-sectional study of tobacco and opium users and matched controls was conducted in the Kharameh Cohort, Fars, Iran. The prevalence of COPD and asthma, along with the participants demographical and spirometry data were examined.

RESULTS

The average age of participants was 57 ± 8 years. Never smokers had a significant higher BMI (26.6 vs. 24.8), FEV1 (91% vs. 82%) and FVC (96% vs. 88%) values compared to participants with a positive smoking status. There was a statistical difference in the prevalence of COPD, asthma, and asthma COPD overlap (ACO) based on the participants smoking status, with the highest prevalence among opium and cigarette smokers, followed by opium users alone. Based on multivariate analysis, higher age, lower BMI, lower education than under diploma, cigarette smoking and opium use were significantly correlated with higher COPD prevalence; while lower age, cigarette smoking and opium use were significantly correlated with higher asthma prevalence. Illiterate participants had a significantly higher prevalence of COPD (23.6%), asthma (22%), and ACO (7.9%) among the educational groups. Regarding the prevalence of asthma, the higher socio-economic group had the lowest prevalence.

CONCLUSIONS

Opium and tobacco users had a significantly higher prevalence of respiratory diseases, along with lower lung function tests based on spirometry evaluation.

Survival features, prognostic factors, and determinants of diagnosis and treatment among Iranian patients with pancreatic cancer, a prospective study

OBJECTIVES

Investigating the survival features, and determinants of treatment and stage at presentation in Iran.

METHODS

461 patients with pancreatic ductal adenocarcinoma (PC) were prospectively enrolled from Shariati hospital, Tehran, Iran, between 2011-2018. All patients underwent endoscopic ultrasonography, computed tomography scanning, and physical examination. Validated questionnaire was completed for the participants and all were actively followed on monthly basis.

RESULTS

Median survival time was 6.5 months, and 1-, and 5-year survival rates were 26.2%, and 1.5%. Patients who were older (p<0.001), illiterate (p = 0.004), unmarried (p = 0.003), rural inhabitant (p = 0.013), opium user (p = 0.039), and had lower body mass index (BMI) (p = 0.002) had lower overall survival. Tumors located in the head of pancreas were more commonly diagnosed at lower stages (p<0.001). Only 10.4% of patients underwent surgery who were more commonly educated (p<0.001), married (p = 0.005), had a tumor located in the head of pancreas (p = 0.016), and were diagnosed at lower stages (p<0.001). After adjustment for potential confounders and risk factors, rural inhabitance (HR: 1.33 (95% CI: 1.01-1.74)), having more symptoms (HR for each increasing symptom: 1.06 (1.02-1.11)), using opium (HR: 1.51 (1.04-2.20)), having a tumor located in the body of pancreas (HR: 1.33 (1.02-1.75)), and having an advanced tumor stage (HR: 2.07 (1.34-3.19)) remained significantly associated with increased risk of mortality. After the adjusting for potential confounders, we did not find significant relationships between smoking, alcohol intake, and BMI with the risk of death among patients with pancreatic cancer.

CONCLUSIONS

Iranian patients with PC have very poor long-term survival. Besides tumor's stage and location, socioeconomic disparities could affect the probabilities of receiving treatment and/or survival in these patients. Opium use is an independent risk factor for mortality among PC patients in Iran.

Evaluation of opioid use among patients with back disorders and arthritis

PURPOSE

Long-term opioid use for chronic pain has increased, but limited evidence exists on its benefits. Evaluation of long-term benefits in pain is based on patient-reported measures such as health-related quality of life (HRQoL). This study examined the long-term effects of opioid use on HRQoL and its subdomains in patients with back pain or arthritis by comparing opioid users to non-opioid users for three metrics: (1) any opioid use, (2) duration of opioid use, and (3) average daily morphine equivalent dose.

METHODS

A nationally representative sample of cancer-free adults with chronic back pain or arthritis was selected. Using the 12-Item Short Form Survey, HRQoL measures of Mental Component Score (MCS), Physical Component Score (PCS), and individual subdomains were assessed at baseline and 1 year later. Opioid users were matched to non-opioid users in a 1:1 greedy match using propensity scores estimated based on many patient demographics and baseline HRQoL measures.

RESULTS

At year one, PCS was significantly lower among opioid users, mostly driven by bodily pain subdomain; MCS was not different. Short-term opioid users (< 1 month) had higher MCS while long-term users (≥ 1 month) had lower PCS. Low-dose [< 20 morphine milligram equivalents (MME)/day] opioid use was associated with lower PCS, while no difference was found between high dose (≥ 20 MME/day) and non-opioid users. However, most differences were not clinically significant.

CONCLUSIONS

Long-term opioid use is not associated with improvements in HRQoL. Clinicians should carefully evaluate the need for opioid use, especially long-term use in managing chronic back pain and arthritis.