P0215First Prospective Characterisation of Opioid-Induced Gastroenteropathy Using a Multidisciplinary Framework

Abstract Background Opioid-induced bowel dysfunction and narcotic bowel syndrome are well-described gastrointestinal (GI) disorders. Prolonged opioid use in high doses, as a longstanding recreational tradition, is common in Rajasthan, a state located in the north-western part of India. Long-standing opioid use can lead to ulceroconstrictive disease of the bowel, mimicking inflammatory bowel disease, particularly Crohn’s disease. This entity is known as opioid gastroenteropathy (OE) and is reported sparingly, mainly as small retrospective studies. Methods We prospectively evaluated consecutive opioid users presenting with GI symptoms. OE was diagnosed in patients with ulceration and/or strictures of the bowel, in persons with opioid use disorder and after carefully excluding other causes of bowel ulceration and strictures. Results Between July 2023 to February 2025, 297 persons with opioid use disorders were enrolled (mean age 58.1 ± 10.1 years; 96.6% male), of which 95 (32%) patients were diagnosed as OE. Average opioid use duration was 18.4±8.6 years, with symptoms present for 12 (IQR: 4-36) months. Common symptoms included abdominal pain (80%), constipation (61%), anorexia (53.7%), weight loss (50.5%), and easy fatiguability (43.2%). Evaluation in patients with OE revealed anaemia (79%) and hypoalbuminemia (69.5%), with endoscopy showing pyloric (6.3%), duodenal (5.3%), and ileal (6.3%) strictures. CT enterography revealed pyloric/duodenal strictures in 5.3%, and jejunal/ileal strictures in 37.9% of the patients. Histopathology from stricture sites (n = 43) showed ischemic changes. The majority of patients with OE had improvement in symptoms, haemoglobin, serum protein, and albumin levels with opioid deaddiction and supportive measures (Figure 1). Conclusion Prolonged opium abuse can result in multifocal ulceration and stricture formation in the GI tract. OE should be recognised as an important differential for ulceroconstrictive bowel disorders in regions with high opium abuse. Conflict of interest: Dr. Birda, Chhagan Lal: No conflict of interest Mathur, Kartikeya: No conflict of interest Agarwal, Ankit: No conflict of interest Singh, Satyam Kumar: No conflict of interest Aggarwal, Divya: No conflict of interest Sureka, Binit: No conflict of interest Agarwal, Ashish: No conflict of interest