title: Increased sedation requirements during endoscopy in patients with celiac disease.
abstract: BACKGROUND
  Celiac disease (CD) is associated with increased rates of neuropsychiatric disease and irritable bowel syndrome, and patients may exhibit visceral hypersensitivity.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether patients with CD have increased sedation requirements during endoscopic procedures.
  
  
  METHODS
  In this retrospective cohort study, we identified CD patients undergoing either a colonoscopy or esophagogastroduodenoscopy (EGD), but not a dual procedure. CD patients were matched with control patients according to age, gender and endoscopist. For sedation requirements we defined "high" as falling outside of the 75th percentile of the entire cohort.
  
  
  RESULTS
  In the colonoscopy analysis we identified 113 CD patients and 278 controls. In the CD group, 29 individuals (26%) required high amounts of both opioids and midazolam, as compared to 46 (17%) controls (P = 0.05). Differences were similar when considering only opioids (P = 0.06) and midazolam (P = 0.06). In the EGD analysis we identified 314 CD patients and 314 controls who met the inclusion criteria. Among the CD patients, 70 (22%) required high amounts of both opioids and midazolam compared to 51 (16%) controls (P = 0.05). Differences were similar when considering only opioids (P = 0.06) and midazolam (P = 0.04).
  
  
  CONCLUSIONS
  Patients with CD require higher doses of sedation during upper and lower endoscopy compared to age and gender-matched controls. Putative explanations, such as visceral hypersensitivity, chronic opioid/anxiolytic use, or underlying neuropsychiatric illness, should be evaluated prospectively.
authors: The Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY, USA. BL114@columbia.edu
authors: Benjamin
authors: B
authors: Lebwohl
authors: Benjamin
authors: B
authors: Hassid
authors: Steven
authors: S
authors: Ludwin
authors: Suzanne K
authors: SK
authors: Lewis
authors: Christina A
authors: CA
authors: Tennyson
authors: Alfred I
authors: AI
authors: Neugut
authors: Peter H R
authors: PH
authors: Green
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002446:Celiac Disease / Q000175:diagnosis*; D003113:Colonoscopy; D016292:Procedural Sedation; D016145:Endoscopy, Digestive System; D005260:Female; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam; D005283:Fentanyl