Chronic opioid use is associated with obstructive and spastic disorders in the esophagus

Abstract

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.

Systematic Review With Meta-Analysis: Chronic Opioid Use Is Associated With Esophageal Dysmotility in Symptomatic Patients

“…A total of 621 publications were identified in the initial search, of which 376 were excluded as duplicates (see Supplementary Figure 1, http://links.lww.com/AJG/C999). After applying these exclusion criteria, a total of 9 full articles involving 10,292 patients (1,749 opioid users and 8,543 nonopioid users) were included in the meta-analysis (4–9,15–17). Most of the included studies were conducted in the United States (n = 8), and one was conducted in Switzerland.…”

“…Specifically, Patel D reported a median opioid use of 30 MME with an IQR of 10–45 MME, Ratuapli S reported a median use of 30 MME with a broader IQR of 3–320 MME, and Babaei A reported a median use of 45 MME with an IQR of 30–90 MME (4,7,8). In Sanchez et al's (9) study, opioid use was categorized into high dose (≥30) and low dose (<30). Information on opioid use was not available in the studies by Ravi et al, Synder et al, and Schindler et al (5,6,16,17).…”

“…Seven studies involving 1,683 opioid users and 7,854 nonopioid users reported the rate of DES (4–9,15,16). Our meta-analysis found that the opioid use was significantly associated with an increased risk of DES (pooled OR 4.84, 95% CI 1.60–14.63, P = 0.005).…”

“…However, there was a high level of heterogeneity in the data (I 2 = 96%) (Figure 1). Seven studies including a total of 1,683 opioid users and 7,854 nonopioid users investigated the rate of hypercontractile esophagus (4–9,15). The results indicated that opioid use was not significantly associated with an increased risk of hypercontractile esophagus compared with nonopioid use (pooled OR 1.87, 95% CI 0.69–5.03, P = 0.22, I 2 = 92%) (Figure 2).…”

High-Resolution-Manometrie des Ösophagus: Wegweiser zur optimalen Therapie

“…Die genannte Symptomatik ist nach Absetzen der Opiate jedoch reversibel. Es treten vor allem die manometrischen Bilder einer EGJOO, einer Achalasie Typ III und eines distalen Ösophagusspasmus gehäuft auf [35,36].…”