Objectives: Dilatation of the common bile duct (CBD) can be an ominous sign for malignancy of the pancreatobiliary tract; however, it has also been described as a presumably harmless side effect of opioid use. We investigated the prevalence and determinants of CBD dilatation among drug users receiving methadone maintenance therapy in the Netherlands.
Methods: A cross-sectional study was conducted in a prospectively studied and well-defined cohort of drug users with chronic hepatitis C virus infection, attending the Public Health Service of Amsterdam, the Netherlands. Patients underwent abdominal ultrasonography as part of pretreatment screening. A multivariable logistic regression model was used to analyze potential demographic and drug use–related determinants of radiological CBD dilatation.
Results: Between September 2004 and December 2011, 222 hepatitis C virus–infected drug users were evaluated. Dilatation of the CBD was found in 50 of 222 patients (22.5%), with a median diameter of 8.0 mm (interquartile range, 7.0 to 10.0; n = 43). Dilatation was associated with current use of methadone (adjusted odds ratio = 20.50; 95% confidence interval, 2.79 to 2.61 × 103), independent of the current methadone dose, and with age per 10-year increase (adjusted odds ratio = 1.68; 95% confidence interval, 1.06 to 2.71). Regular use of heroin in the 6 months before ultrasonography was not found to be associated with dilatation.
Conclusions: Dilatation of the CBD is common in drug users under methadone treatment and seems to be a harmless side effect of opioid agonists.
From the Department of Research (SJL, BPXG, CEAL, MP), Cluster Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands; Center of Infectious Diseases and Immunology Amsterdam (BPXG, CEAL, MP) and Department of Gastroenterology and Hepatology (UB, CJW), Academic Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine (MP), Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands.
Send correspondence and reprint requests to Bart P.X. Grady, MD, Department of Research, Cluster Infectious Diseases, Public Health Service Amsterdam, Room B1.13A, PO Box 2200, 1000 CE Amsterdam, the Netherlands. E-mail: firstname.lastname@example.org.
The Amsterdam Cohort Studies, a collaboration between the Public Health Service Amsterdam (PHSA), the Academic Medical Center of the University of Amsterdam, Sanquin Blood Supply Foundation, and the University Medical Center Utrecht, and part of the Stichting HIV Monitoring are funded by the Netherlands National Institute for Public Health and the Environment. Additional funding sources for this study were the PHSA Research and Development foundation, ZonMW (grant 7115 0001), Merck/Schering Plough, and AGIS health insurance.
The authors declare no conflicts of interest.
The funding institutions had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
The first 2 authors contributed equally to this article. S.L. and B.G. drafted the manuscript and interpreted the data; B.G. performed statistical analyses; S.L., B.G., K.L., and C.W. acquired data; and K.L., M.P., U.B., and C.W. critically revised the manuscript.
Received May 25, 2013
Accepted October 16, 2013