Gastric Outlet Obstruction and Drug Abuse: A Growing Concern

In a stark and alarming trend, a medical center in India has witnessed a significant upswing in cases of gastric outlet obstruction (GOO) with drug abuse, emerging as a prominent contributing factor. The urgency to address this concerning surge prompted an observational study, conducted from September 2017 to February 2019, to delve into the incidence of abuse involving nonsteroidal anti-inflammatory drugs (NSAIDs) and synthetic opioids among individuals diagnosed with GOO.

The study was published in the Journal of the Association of Physicians of India.

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The research, involving consecutive cases of GOO, aimed to comprehensively understand the extent of drug abuse's role in this debilitating condition. Each case underwent a thorough examination, including detailed drug addiction histories and clinical assessments. Diagnostic investigations spanned routine biochemical and hematological tests, upper gastrointestinal endoscopy (UGIE), ultrasonography, rapid urease test (RUT), and meticulous histopathological analysis of the affected areas.

Findings

Out of the 102 diagnosed cases of GOO, a staggering 60.78% (62 cases) had a documented history of drug addiction.

• Combined NSAIDs and opioid abuse in 56 cases
• Opioids alone in four cases
• NSAIDs alone in two cases

Intriguingly, the second part of the duodenum emerged as the most commonly affected site, underscoring the severity and complexity of these cases. Histopathological examinations offered deeper insights, uncovering mucosal ulcerations infiltrated by eosinophils, plasma cells, and lymphocytes.

The study's revelations point towards a pressing issue within our community – the growing incidence of GOO linked to the abuse of NSAIDs and opioids. It is not merely a statistical concern but a human concern, reflecting the real impact on individuals' lives. The high prevalence of drug addiction histories among diagnosed cases raises urgent red flags, prompting healthcare professionals and policymakers alike to consider immediate and targeted interventions.

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The findings underscore the need for concerted efforts to control the indiscriminate use of over-the-counter drugs, particularly NSAIDs and opioids. The complications observed in these cases serve as a poignant reminder of the potentially severe consequences associated with unchecked drug abuse. This calls for a collaborative approach, involving healthcare practitioners, policymakers, and the community, to implement preventive measures, raise awareness, and curb the alarming trend of GOO linked to substance abuse.

Further reading: 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. DOI: 10.59556/japi.71.0432