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Opioid and Opioid-Like Drug Effects on Whole-Gut Transit Measured by Scintigraphy

Departments of Diagnostic Imaging, Division of Nuclear Medicine and Medicine, Section of Gastroenterology, Temple University School of Medicine, Philadelphia, Pennsylvania

Correspondence: For correspondence or reprints contact: Alan H. Maurer, MD, Director, Nuclear Medicine, Temple University Hospital, Broad and Ontario Streets, Philadelphia, PA 19140.

ABSTRACT

We studied the effects of several drugs on gastrointestinal transit (tramadol HCl, acetaminophen with codeine and placebo) in a randomized, double-blind, crossover study. Methods: Combined gastric emptying, small bowel and colonic transit scintigraphy was performed in 12 normal subjects. Each subject received a standardized diet and study drug on Days 1–5. On Day three, subjects received a radiolabeled solid and liquid phase meal. Results: No significant difference in the gastric T_1/2 (mean ± s.e.m.) of solids for placebo (69 ± 7 min), APAP/C (74 ± 15 min) or tramadol (686 ± 8 min) (p = 0.86) were seen. Similarly there was no significant difference in the T_1/2 of liquids for placebo (31 ± 4 min), APAP/C (41 ± 6 min) or tramadol (41 ± 7 min) (p = 0.29). Orocecal transit times were not significantly different for placebo (237 ± 20 min), APAP/C (311 ± 26 min) or tramadol (311 ± 10 min) (p = 0.12). Colon geometric centers (GC) for placebo at 24, 48 and 72 hr were 4.6 ± 0.35, 6.0 ± 0.28 and 6.8 ± 0.08. The GC for tramadol and APAP/C were all significantly lower at 72 hr, 6.4 ± 0.17 and 6.2 ± 0.17, respectively compared to the placebo. The GC of tramadol at 24 and 48 hr (3.8 ± 0.4, 5.4 ± 0.26) were not significantly different from placebo. In contrast, the GC for APAP/C at 24 and 48 hr (3.3 ± 0.31, 5.0 ± 0.26) were significantly delayed. All subjects recorded a significant increase in constipation on drugs compared to placebo (p = 0.04). Conclusion: Tramadol and APAP/C had no effect on gastric emptying or small bowel transit. At equianalgesic doses, tramadol caused less delay in colonic transit than APAP/C for 48 hr and delay in the GC agreed with the subjective complaints of constipation on both drugs.

Key Words: gastric emptying • small bowel transit • colon transit • opioid drugs