Background and Aims: Chronic opioid effects on the esophagus are poorly understood. We investigated whether opioids were associated with increased prevalence of esophageal motility disorders.Methods: A retrospective study of all patients undergoing high-resolution manometry (HREM) at the Yale Gastrointestinal Motility Lab between January 2014 and August 2019. Data were extracted from the electronic medical record after studies were reviewed by two motility specialists using the Chicago Classification v.3.0. We compared the manometric results of patients who use opioids to those who do not and adjusted for type and dose of opioids using a 24 h Morphine Milligram Equivalents (MME) scale to compare patients taking low or high amounts of opioids.Results: Four manometric abnormalities were significantly different between the opioid and non-opioid users. Achalasia type III, esophagogastric junction outflow obstruction (EGJOO), and distal esophageal spasm (DES) (p < 0.005, p < 0.01, and p < 0.005, respectively) were common among opioid users, whereas ineffective esophageal motility (IEM) was more common among non-opioid users (p < 0.01). The incidence of EGJOO was significantly higher in opioid users compared to non-opioid users (p < 0.001). Lastly, IRP, DCI, and distal latency were significantly different between the two groups.Patients in the high MME group had significantly greater IRP, DCI, and lower distal latency than non-opioids (p < 0.001). Also, achalasia type III and DES were more common in the high but not the low MME group.Conclusions: Opioid use is associated with multiple abnormalities on esophageal motility and these effects may be dose-dependent.
P reparation materials forStep 1 of the United States Medical Licensing Exam (USMLE) describe patients with substance use disorders (SUDs) using outdated, stigmatizing terminology. In preparation for the Step 1 exam, students complete question banks with thousands of vignette-based, board-style questions and answer explanations. As medical students preparing for Step 1 in 2020, we noted terms like "abuser," "addict," and "alcoholic" within popular question banks (UWorld, Kaplan, and USMLERx) and National Board of Medical Examiners (NBME) practice exams. This language derives from the systematic criminalization of people who use drugs and has been replaced by contemporary terms (e.g., use disorders) within the medical community.Terms like "substance abuser" perpetuate provider stigma and negatively influence patient care and outcomes. 1 In 2013, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) introduced contemporary diagnostic categories for SUDs and person-first terminology. Person-first terminology, originating from the disability rights movement, aims to humanize patients and retain their identities separate from their medical conditions. An example of person-first terminology is a "person with an opioid use disorder" as opposed to a "heroin user." Additionally, many medical fields have removed pejorative terms, like "abuser," "addict," or "alcoholic," from their literature. 2 These changes aim to reduce the high level of bias healthcare providers harbor about SUDs, which discourages people with SUDs from seeking or continuing care and reduces the quality of care they receive. 3 Step 1 is the first USMLE taken by aspiring physicians and integrates basic science into clinical scenarios. Students succeed by recognizing patterns and forming associations to identify
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