Lower prevalence of gastroesophageal reflux disease in patients with noncardiac chest pain on opiates: a cross-sectional study

Abstract

Opiates can cause heartburn and spastic esophageal dysmotility but their role in noncardiac chest pain (NCCP) is not known. Our aim was to characterize opiate effects on esophageal function using esophageal pH monitoring and high-resolution manometry (HREM) in these patients.We performed a cross sectional study of opiate users with NCCP who underwent HREM and esophageal pH study from 2010 to 2017 using opiate nonusers as a comparison group. Demographic data, symptoms, opiate use, endoscopic findings, esophageal pH study parameters, and HREM data were abstracted.Thirty three patients with NCCP on opiates were compared to 144 opiate non-users. Compared to opiate nonusers, opiate users had lower total acid exposure (2.3% vs. 3%, P = 0.012), lower upright acid exposure (1.2% vs. 3.1%, P = 0.032) and lower DeMeester score (6.5 vs. 12.7, P = 0.016). Opiate users also had higher lower esophageal sphincter integrated relaxation pressure (LES-IRP) (7.0 mm Hg [2.2, 11.7] vs. 3.7 mm Hg [1.1, 6.2] P = 0.011) and greater mean distal contractile integral (DCI) (2575 mm.Hg.s.cm [1134, 4466] vs. 1409 mm.Hg.s.cm [796, 3003] P = 0.03) than opiate non-users. The prevalence of hypertensive motility disorders (15.2% vs. 11.1%) and achalasia (12.1% vs. 2.1%) was higher in opiate users (P = 0.039) but did not reach significance on multivariate analysis.In patients presenting with NCCP, opiate users had lower esophageal acid exposure compared to opiate nonusers. This might be due to higher LES pressures preventing reflux and higher DCI leading to more rapid acid esophageal clearance.

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.…”

“…To determine the effect of opioid use on EGJOO, a meta-analysis was conducted on 8 studies comprising 1,711 opioid users and 8,201 nonopioid users (4–9,15,16). The results showed a significant increase in the risk of EGJOO in opioid users compared with nonopioid users (pooled OR 5.13, 95% CI 2.11–12.43, P = 0.0003, I 2 = 93%) (Figure 3).…”

Opioid-induce esophageal dysfunction, prevalence and manometric findings

“…Cifuentes et al (19), evaluated patients with non cardiac chest pain taking opioids that underwent HRM and ambulatory pH monitor testing, noteworthy; they found that opioid consumption is associated with a significantly lower esophageal total acid exposure. They attribute this finding to a higher LES resting pressure, which reduces reflux episodes, and a greater DCI that may enhance esophageal acid clearance mechanism.…”

Chronic opioid users with dysphagia are indistinguishable from symptomatic nonusers on functional lumen imaging probe evaluation

“…5 Consequently, opioid medications can result in both obstructive (i.e., dysphagia) and perceptive (i.e., heartburn, chest pain) esophageal symptoms. 6 Functional lumen imaging probe (FLIP) adapts impedance planimetry to provide real-time cross-sectional area and bolus transit information in response to volumetric balloon distension during sedated upper endoscopy. 7 Abnormal esophagogastric junction (EGJ) opening can be characterized based on EGJ diameter and distensibility index (DI).…”

“…Chronic use of opioid medications potentiates pain transmission pathways, leading to accentuation of perceptive sensations including esophageal pain 5 . Consequently, opioid medications can result in both obstructive (i.e., dysphagia) and perceptive (i.e., heartburn, chest pain) esophageal symptoms 6 …”