Chronic opioid use is associated with altered gut microbiota and predicts readmissions in patients with cirrhosis

[Diffusé le 21-12-2016]

Source : Alimentary Pharmacology & Therapeutics 2017; 45(2): 319-31

C. Acharya 1, N. S. Betrapally 2, P. M. Gillevet 2, R. K. Sterling 1, H. Akbarali 3, M. B. White 1, D. Ganapathy 1, A. Fagan 1, M. Sikaroodi 2, J. S. Bajaj 1

1Division of Gastroenterology and Hepatology McGuire VA Medical Center and Virginia Commonwealth University Medical Center Richmond >VA> USA
2Microbiome Analysis Center George Mason University Manassas >VA> USA
3Department of Pharmacology and Toxicology McGuire VA Medical Center and Virginia Commonwealth University Medical Center Richmond >VA> USA

L'utilisation chronique d'opioïdes est associée à un microbiote intestinal altéré et engendre des réadmissions chez les patients atteints de cirrhose

Article commenté par : L'équipe éditoriale AddictoScope

Chez les patients atteints d'une maladie hépatique avancée, la prise d’opioïdes est particulièrement risquée du fait que de nombreux opioïdes sont métabolisés dans le foie, ce qui pourrait affecter leur métabolisme. L’étude démontre que l’usage chronique d’opioïdes chez des patients cirrhotiques est associé à une augmentation de l’endotoxémie, de la dysbiose et des réadmissions.

Summary

Background Opioid use is epidemic in cirrhosis, which could precipitate hepatic encephalopathy (HE) potentially through gut dysbiosis and inflammation.
Aim To define the effect of opioids on readmissions and on gut microbiota composition and functionality.
Methods Cohort 1 had 200 cirrhotic in‐patients (with/without opioid use) followed prospectively through the index hospitalisation and 6 months post discharge. Readmissions (HE‐related/unrelated) were compared between patients discharged on opioids compared to the rest, including using a multi‐variable analysis. Cohort 2 consisted of 72 cirrhotics on chronic opioids who were age/model for end‐stage liver disease (MELD) and prior HE‐balanced with 72 cirrhotics not on opioids. Stool microbiota composition (multi‐tagged sequencing), predicted functionality (PiCRUST), endotoxemia and systemic inflammation (IL‐6, IL‐17) were compared.
Results Cohort 1: Chronic opioid use was statistically similar between those admitted with/without HE, and was judged to be an HE precipitant in <5% of cases during the index hospitalisation. Of the 144 patients alive at 6 months, 82 were readmitted. The opioid users had a significantly higher all cause (69% vs. 48%, P = 0.008), but not HE‐related readmissions (30% vs. 41%, P = 0.30). On regression, opioid therapy and female gender were predictive of readmission independent of MELD score and previous HE. Cohort 2: Significant dysbiosis was noted in the opioid cohort, especially in HE+opioid patients with lower autochthonous taxa and Bacteroidaceae relative abundance. PiCRUST showed highest aromatic amino acid and endotoxin production in opioid users. Opioid users also had higher endotoxemia and IL‐6 but not IL‐17.
Conclusion Chronic opioid use in cirrhosis is associated with increased endotoxemia, dysbiosis and all‐cause readmissions.


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