The Impact of Antispasmodic Use on Abdominal Pain and Opioid Use in Inflammatory Bowel Disease: A Population-Based Study

Abstract

Background

Patients with inflammatory bowel disease (IBD) are often prescribed antispasmodics for chronic abdominal pain. Large-scale data regarding efficacy and impact on clinical outcomes are lacking.

Aim

To examine the association between antispasmodic use and outcomes of abdominal pain and opioid use before and after propensity matching key demographic and clinical characteristics.

Methods

We used TriNetX Diamond Network, a medical and claims database. Patients were stratified by baseline abdominal pain and opioid use. Secondary outcomes were corticosteroid use, IBD-related complications and surgeries, emergency room (ER) visits, hospitalisation and mortality.

Results

We included 85,859 patients (median age 50; 53.8% female) with IBD; 5661 used antispasmodics. On follow-up, those with antispasmodic use had higher rates of abdominal pain and opioid use (p < 0.001) regardless of baseline abdominal pain or opioid use. After matching, 5629 patients remained per group. Patients who used antispasmodics had higher rates of abdominal pain at 1 month, regardless of baseline abdominal pain. Opioid-naïve patients who used antispasmodics had higher rates of opioid use at follow-up (1.1% vs. 0.2%; p < 0.001). The likelihood of corticosteroid use, clinic visits, ER visits and hospitalisation were higher in those with antispasmodic use. No differences in IBD-related complications, surgery or mortality were observed.

Conclusions

Antispasmodic use in patients with IBD was associated with increased abdominal pain and opioid use in opioid-naïve patients. Antispasmodic use was associated with increased likelihood of corticosteroid use, clinic and ER visits and hospitalisation.