Rahul Patel, DO1, Darshan Patel, DO1, Edward Bley, DO2, Marisa Pope, DO2, Christopher Chhoun, DO2, Seth Lipshutz, DO2, Sachin Prasad, DO2, C. Jonathan Foster, DO1, Drew Chiesa, DO2 1Jefferson Health, Stratford, NJ; 2Jefferson Health, Sewell, NJ Introduction: Constipation is a prevalent gastrointestinal condition affecting a significant portion of people worldwide. In the setting of comorbidities and the reliance on certain medications, constipation can become a debilitating condition. We report a unique treatment method in a patient with constipation multifactorial to multiple sclerosis and chronic opioid use.
Case Description/
Methods: A 47-year-old male weighing 76 kg with a history of multiple sclerosis (MS) complicated by quadriplegia, chronic pain requiring opioids and neurogenic bladder/bowel presented to the hospital with 9 days of constipation. His bowel regimen is polyethylene glycol 17g 3 times a day, lubiprostone 24mcg daily, 2 tablet of senna 8.6mg twice daily, and naloxegol 12.5mg daily. A computerized tomography (CT) of the abdomen/pelvis without contrast on arrival showed a high stool burden in the rectosigmoid colon and moderate constipation in the remainder of the colon. The patient's constipation was attributable to a multifactorial etiology, encompassing opioid-induced effects and neurogenic bowel dysfunction secondary to multiple sclerosis. As a result, he was given a 12mg injection of methylnaltrexone and several hours later he had a significant bowel movement. The following day he was given another 12mg injection of methylnaltrexone with further relief of constipation. Due to recurrent hospitalization with constipation, he was recommended to follow up with general surgery outpatient for consideration of an ileostomy. Discussion: This case highlights the effectiveness of combining methylnaltrexone with naloxegol in managing refractory constipation in a patient with MS and chronic opioid use. Despite a comprehensive bowel regimen, including polyethylene glycol, lubiprostone, senna, and naloxegol, the patient’s constipation persisted, likely due to the multifactorial nature of his condition—opioid-induced constipation compounded by neurogenic bowel dysfunction from MS. Methylnaltrexone, a peripherally acting opioid antagonist, provided significant relief when administered in conjunction with naloxegol, resulting in prompt bowel movements. This approach mirrors findings in recent studies, such as Kalam et al. (2020), which show methylnaltrexone's efficacy in opioid-treated patients. While promising, further research is needed to assess the long-term safety and efficacy of this combined approach in similar patient populations.
Disclosures: Rahul Patel indicated no relevant financial relationships. Darshan Patel indicated no relevant financial relationships. Edward Bley indicated no relevant financial relationships. Marisa Pope indicated no relevant financial relationships. Christopher Chhoun indicated no relevant financial relationships. Seth Lipshutz indicated no relevant financial relationships. Sachin Prasad indicated no relevant financial relationships. C. Jonathan Foster indicated no relevant financial relationships. Drew Chiesa indicated no relevant financial relationships.
Rahul Patel, DO1, Darshan Patel, DO1, Edward Bley, DO2, Marisa Pope, DO2, Christopher Chhoun, DO2, Seth Lipshutz, DO2, Sachin Prasad, DO2, C. Jonathan Foster, DO1, Drew Chiesa, DO2. P5102 - Combined Efficacy of Methylnaltrexone and Naloxegol in Managing a Case of Neurogenic and Opioid-Induced Constipation, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
