乌鸦传媒

ORLANDO -- Alvimopan, an oral peripherally acting mu-opioid receptor antagonist, decreased postoperative ileus after major abdominal surgery among patients with inflammatory bowel disease (IBD), researchers reported here.

A retrospective chart review found that patients with IBD who received alvimopan had a faster gastrointestinal recovery compared with patients who received standard care (HR 2.11, 95% CI 1.63-2.73, P<0.001), reported Janice Jang, MD, of NYU Langone Medical Center in New York City, and colleagues.

Using linear regression to control for type of bowel resected, type of surgery, type of IBD, and age, the team found that patients who received alvimopan spent 2.59 fewer days in the hospital compared with the control group (P<0.01), said Jang during a poster session at .

Mohammed Bayasi, MD, of Medstar Washington Hospital Center in Washington, D.C., who was not involved with the study, commented that alvimopan is commonly used to decrease postoperative ileus in patients with other conditions: "It's been used for colon surgery for a long time, but this study shows that it is effective in inflammatory bowel disease patients," he told 乌鸦传媒, explaining that "often times it's not used very well for IBD patients because they are already on narcotics, so there could be contraindications."

Jang and colleagues on IBD patients from a 725-bed acute care teaching hospital in New York City. All patients underwent bowel resection from January 2012 to February 2017 and received either preoperative alvimopan (N=121) or standard care (N=126). The male-to-female ratio was 51:49, and the mean age of the patients was 43.2 in the alvimopan group and 44.4 among the controls.

Rates of bowel resection varied between the alvimopan and placebo groups: Small bowel only (27.3% versus 51.6%), large bowel only (30.6% versus 19.0%), and both (42.1% versus 29.4%). Ulcerative colitis was reported in 57.0% of patients on alvimopan and 58.7% of controls, with slightly lower rates of Crohn's disease in both groups ( 43.0% versus 38.1%, respectively).

In addition, Jang said, patients who received alvimopan had higher rates of laparoscopic surgery (64.5% versus 31.0%), while the control group was more likely to have open surgery (69.0% versus 35.5%).

Of importance, the researchers noted that approximately half of patients who underwent bowel surgery after March 2015 were placed on a "colon surgery pathway" -- a strategy to decrease the length of stay and postoperative complications through early feeding, an optimized analgesia regimen, use of incentive spirometry, and administration of alvimopan peri-procedurally.

NYU created the pathway in 2012 to better standardize care so that from day 0, patients can receive clear liquid diet, and then automatically upgrade to solid foods once they pass flatus or have a bowel movement, Jang explained to 乌鸦传媒. The initiate also addresses pain management and this particular pathway incorporated drugs like toradol or high doses of acetaminophen (Tylenol) to augment opioid use.

The researchers found that patients who received alvimopan experienced shorter time to first flatus (HR 2.02, 95% CI 1.54-2.64, P<0.001) and to first bowel movement (HR 1.93, 95% CI 1.48-2.50, P<0.001).

They were also sooner able to tolerate both a liquid diet (HR 2.482, 95% CI 1.90-3.24, P<0.001) and a solid food diet (HR 1.999, 95% CI 1.54-2.59, P<0.001) compared with patients in the control group.

“The caveat is that the alvimopan group, some of them were on the colon pathway and some were not because we collected patients from 2011 onwards and the pathway started in 2012,” Jang explained to 乌鸦传媒. “We’re not sure how much of a difference the other areas of the pathway made, but we still think that alvimopan contributed a great deal to speeding up recovery after surgery.”

The researchers’ next step is to assess out the differences in patients who received alvimopan, before and after 2012, in order to see what role the colon surgery pathway might have played.

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