Effects of remifentanil on esophageal and esophagogastric junction (<scp>EGJ</scp>) bolus transit in healthy volunteers using novel pressure‐flow analysis

Cock, Charles; Doeltgen, Sebastian; Omari, Taher; Savilampi, Johanna

doi:10.1111/nmo.13191

Cited by 12 publications

(11 citation statements)

References 50 publications

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“…Previous research observed that chronic opioid use also affected esophageal function, causing symptoms of dysphagia and a manometric pattern of functional esophagogastric junction-outflow obstruction (EGJ-OO) and achalasia assessed by high-resolution manometry (HRM). [6][7][8] More recently, Ortiz et al postulated a new entity known as opioid-induced esophageal dysfunction (OIED) referring to esophageal motility disorders caused by chronic use of opioids. 9 It was also observed that the prevalence of OIED is higher in patients taking higher doses of opioids.…”

Section: Introductionmentioning

confidence: 99%

Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double‐blind, placebo‐controlled, cross‐over trial

Geeraerts

Geysen

Ballet³

et al. 2020

Neurogastroenterology Motil

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Background: Chronic opioid use can induce esophageal dysfunction with symptoms resembling achalasia and a manometric pattern of esophagogastric junction-outflow obstruction (EGJ-OO). However, the effect of opioids in acute setting on pharyngeal function and esophageal body contractility has not been investigated. Methods: After positioning the high-resolution impedance manometry (HRiM) catheter, codeine (60 mg) or placebo (glucose syrup) was infused intragastrically. Fortyfive minutes post-infusion, participants received liquid, semi-solid, and solid boluses to assess esophageal and pharyngeal function. HRiM analysis was performed adhering to the Chicago classification v3.0. (CC v3.0). Pressure flow analysis (PFA) for the esophageal body and the pharynx was performed using the SwallowGateway™ online platform. Key Results: Nineteen healthy volunteers (HV) [5 male; age 38.3] were included. After codeine administration, higher integrated relaxation pressure 4 s values resulted in significantly reduced deglutitive EGJ relaxation and distal latency was significantly shorter. Distal contractility was similar in both conditions. Bolus flow resistance at the EGJ and distention pressures increased significantly after codeine infusion. Based on CC v3.0, acute infusion of codeine induced EGJ-OO in six HV (p = 0.0003 vs. placebo).Codeine administration induced no significant alterations in any of the pharyngeal PFA metrics. Conclusions & Inferences:In HV, acute administration of codeine increased bolus resistance at the EGJ secondary to induced incomplete EGJ relaxation leading to major motility disorders in a subset of subjects including EGJ-OO. However, an acute single

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Section: Introductionmentioning

confidence: 99%

Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double‐blind, placebo‐controlled, cross‐over trial

Geeraerts

Geysen

Ballet³

et al. 2020

Neurogastroenterology Motil

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“…17,18 Intravenous remifentanil was reported to increase LES relaxation pressures (IRP) and reduce distal latencies in healthy volunteers in 1 study, 19 while another study reported no associated change in IRP, but a reduction in distal latency measures. 20 This latter study also demonstrated a reduction in trans-EGJ bolus flow utilizing the BFT after remifentanil. 20 Studies assessing the effect of intravenous midazolam on esophageal motility have yielded inconsistent results: one demonstrated increased basal EGJ pressure and increased LES relaxation pressures among healthy asymptomatic adults, 9 while another demonstrated no changes in LES pressures among pediatric patients.…”

Section: Discussionmentioning

confidence: 68%

“…20 This latter study also demonstrated a reduction in trans-EGJ bolus flow utilizing the BFT after remifentanil. 20 Studies assessing the effect of intravenous midazolam on esophageal motility have yielded inconsistent results: one demonstrated increased basal EGJ pressure and increased LES relaxation pressures among healthy asymptomatic adults, 9 while another demonstrated no changes in LES pressures among pediatric patients. 10 Overall, while previous studies reported changes in esophageal motility parameters with administration of intravenous opioids or benzodiazepine generally among healthy volunteers, there were some inconsistencies in findings between studies and all of the studies were reported using experimental conditions.…”

Section: Discussionmentioning

confidence: 68%

Performing High-resolution Impedance Manometry After Endoscopy With Conscious Sedation Has Negligible Effects on Esophageal Motility Results

Carlson

Donnan

et al. 2020

J Neurogastroenterol Motil

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Background/Aims High-resolution manometry (HRM) performed without sedation is the standard procedure. However, some patients cannot tolerate transnasal placement of the manometry catheter. We aim to assess the practice of performing manometry after endoscopy with conscious sedation by evaluating its impact on esophageal motility findings. Methods Twelve asymptomatic adult volunteers and 7 adult patients completed high-resolution impedance manometry (HRIM) approximately 1 hour after conscious sedation with midazolam and fentanyl (post-sedation) and again on a different day with no-sedation. The nosedation HRIM involved 2 series of swallows separated in time by 20 minutes (no-sedation-1 and no-sedation-2) for the volunteers; patients completed only 1 series of swallows for no-sedation HRM. Results A motility diagnosis of normal motility was observed in all 12 volunteers post-sedation. Two volunteers had a diagnosis of borderline ineffective esophageal motility, one during the no-sedation-1 period and the other during the no-sedation-2 period; all of the other no-sedation HRIM studies yielded a normal motility diagnosis. Six of seven patients had the same diagnosis in both no-sedation and post-sedation HRM, including 1 distal esophageal spasm, 3 achalasia (2 type II and 1 type III), and 2 esophagogastric junction outflow obstruction. Only one patient's HRM classification changed from ineffective esophageal motility at no-sedation to normal esophageal motility at post-sedation. Conclusions Performing HRIM after endoscopy with conscious sedation had minimal clinical impact on the motility diagnosis or motility parameters. Thus, this approach may be a viable alternative for patients who cannot tolerate unsedated catheter placement.

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“…Recent studies utilizing HRM have shown that opioids use increased LES pressure and is associated with hypercontractility. 15,23,[26][27][28] A large sample size series conducted by Ratuapli et al 15 further demonstrated an association between chronic opioid use and esophageal motor dysfunction. They found that the main opioid-related esophageal disorders are EGJOO and type III achalasia, and the other dysmotility described are distal esophageal spasm (DES) and hypercontractile esophagus, a clinical entity which has been termed opioid-induced esophageal dysfunction (OIED).…”

Section: Discussionmentioning

confidence: 98%

Effects of codeine on esophageal peristalsis in humans using high resolution manometry

Chen

Wong

Hung

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Opioid receptors agonists have been demonstrated to impair lower esophageal sphincter (LES) relaxation and induce spastic esophageal dysmotility, but little was known for their impact on distension-induced secondary peristalsis. The aim of the study was to investigate the hypothesis whether acute administration of codeine can influence physiological characteristics of primary and secondary peristalsis in healthy adults. Methods: Eighteen healthy volunteers (13 men, mean age 27.5 years, aged 20-43 years) underwent high resolution manometry (HRM) with a catheter containing an injection port in mid-esophagus. Secondary peristalsis was performed with 10 and 20 mL rapid air injections. Two different sessions including acute administration of codeine (60 mg) or the placebo were randomly performed. Results: Codeine significantly increased 4-s integrated relaxation pressure (IRP-4s) (P = 0.003) and shortened distal latency (DL) (P = 0.003) of primary peristalsis. The IRP-4s of secondary peristalsis was also significantly higher after codeine than the placebo during air injections with 10 mL (P = 0.048) and 20 mL (P = 0.047). Codeine significantly increased the frequency of secondary peristalsis during air injections with 10 mL than the placebo (P = 0.007), but not for air injection with 20 mL (P = 0.305). Conclusions: In addition to impair LES relaxation and reduce distal latency of primary peristalsis, codeine impairs LES relaxation of secondary peristalsis and increases secondary peristaltic frequency. Our study supports the notion in human esophagus that the impact of opioids on peristaltic physiology appears to be present in both primary and secondary peristalsis.* P-value < 0.05 was considered statistically significant.Data are shown as the mean ± standard errors of the mean. DCI, distal contractile integral; DL, distal latency; IRP-4s, 4-s integrated relaxation pressure; SE, standard error of mean.

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Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure‐flow analysis

Abstract: Remifentanil-induced effects were different for proximal and distal esophagus, with a reduced time for trans-sphincteric bolus flow at the EGJ, suggestive of central and peripheral μ-opioid agonism. There were no functional consequences in healthy subjects.

Cited by 12 publications

References 50 publications

Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double‐blind, placebo‐controlled, cross‐over trial

Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double‐blind, placebo‐controlled, cross‐over trial

Performing High-resolution Impedance Manometry After Endoscopy With Conscious Sedation Has Negligible Effects on Esophageal Motility Results

Effects of codeine on esophageal peristalsis in humans using high resolution manometry

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