Opioid Exposure Differentially Impacts Esophageal Body Contraction Over the Lower Esophageal Sphincter

Patel, Dhyanesh A.; Goss, James; Hayat, Muhammad Hashim; Tombazzi, Claudio; Naik, Rishi D.; Slaughter, James C.; Aslam, Muhammad; Sarker, Shabnam; Higginbotham, Tina; Vaezi, Michael F.

doi:10.1053/j.gastro.2022.04.051

Cited by 17 publications

(41 citation statements)

References 22 publications

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“…These changes highlighted the inconsistent connections observed between abnormal HRM patterns and relevant clinical symptoms, their frequent presence in individuals without esophageal complaints, and the variable outcomes of treatment targeting these findings. Given the increased prevalence of abnormal HRM findings among opioid users persistently reported in prior studies ( 3 – 5 ), our findings seem to offer further evidence that certain abnormal HRM findings alone (e.g., elevated IRP) may not correlate with or sufficiently account for dysphagia complaints, and additional testing or supportive evidence are needed.…”

Section: Discussionmentioning

confidence: 50%

“…Opioid-induced esophageal dysfunction (OIED) has been described with characteristic HRM features including elevated IRP, DES, HE, and type III achalasia. Prevalence of OIED also seems to increase with more potent and higher doses of opioid ( 3 – 5 , 7 ). However, prior studies of OIED primarily included only patients with esophageal symptoms referred for HRM.…”

Section: Discussionmentioning

confidence: 99%

“…All analyses were performed using SAS 9.4 with survey procedures to account for the complex sampling design. The NAMCS provides data on physician visits rather than specific patients and its sampling methods were previously validated to provide population-level estimates from the collected sample of visits ( 5 ). Univariate analyses were performed using the Student t test and χ 2 tests.…”

Section: Methodsmentioning

confidence: 99%

“…There has been a significant increase in opioid prescriptions over the past 20 years, with multiple reported gastrointestinal side effects and dysmotility ( 1 ). Prior studies have consistently shown increased abnormal esophageal manometry patterns among patients taking opioids, including an elevated integrated relaxation pressure (IRP), distal esophageal spasm (DES), hypercontractile esophagus (HE), and type III achalasia ( 2 – 5 ). Despite these manometric changes, the correlation between opioid use and symptomatic dysphagia has not been directly established because prior studies have mainly focused on patients clinically referred for high-resolution manometry (HRM) due to esophageal complaints.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Opioid Use and Outpatient Visits for Dysphagia: An Analysis of the National Ambulatory Medical Care Survey in 2008–2018

Flanagan

Lopes

Brown

et al. 2022

Clinical and Translational Gastroenterology

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INTRODUCTION: Opioid-induced esophageal dysfunction has been described with characteristic manometric patterns, but the population burden of dysphagia attributable to opioid use remains unclear. METHODS: The National Ambulatory Medical Care Survey from 2008 to 2018 was used to assess the relationship between opioid use and outpatient visits for dysphagia. RESULTS: After controlling for potential confounders, there were no significant difference in ambulatory visits for dysphagia between opioid users and nonusers (adjusted odds ratio = 0.98, confidence interval: 0.59–1.65). DISCUSSION: No correlation between opioid use and ambulatory visits for dysphagia was found in a nationwide sample. Opioid-related manometric changes may be clinically relevant only in a small proportion of patients.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association Between Opioid Use and Outpatient Visits for Dysphagia: An Analysis of the National Ambulatory Medical Care Survey in 2008–2018

Flanagan

Lopes

Brown

et al. 2022

Clinical and Translational Gastroenterology

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“…This causes abnormal esophageal motor function including vigorous, premature or simultaneous esophageal body contractions, and impaired relaxation of the LES. These abnormalities are classified on high‐resolution esophageal manometry (HRM) as EGJOO, DES, achalasia type III, and Jackhammer (hypercontractile) esophagus 9,21–23 . Our group tested this hypothesis by studying the impact of opioids on deglutitive inhibition during the multiple rapid swallows (MRS) sequence on HRM.…”

Section: Opioid‐induced Esophageal Dysfunction: Pathophysiologymentioning

confidence: 99%

Impact of opioids on esophageal motility

Snyder

Vela

2023

Neurogastroenterology Motil

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United States (US) and this will likely increase as the population continues to age. Chronic opioids are prescribed to 3%-4% of the US population with a rise in opioid related deaths to more than 440,000 between 1999 and 2018. 1 Prescription opioid use in Europe has also increased over the last decade, but the subsequent harms are less well defined. 2 Chronic opioid use increases risk for abuse, dependence, and overdose. In response to the opioid epidemic, the Centers for Disease Control and Prevention (CDC) released guidelines in 2016 to advise US medical providers on safe practices for prescribing opioids with a recent update last year. 3,4 Opioids are also known to cause adverse effects in the gastrointestinal tract including gastroparesis symptoms such as nausea and vomiting as well as constipation. [5][6][7] The effects of opioids on esophageal function are less understood, but increasing in recognition. [5][6][7][8] Recently, opioidinduced esophageal dysfunction (OIED) has been described as a clinical syndrome defined by chronic opioid use (≥3 months), esophageal symptoms, and esophageal motility abnormalities diagnosed by manometry including achalasia type III, hypercontractile esophagus, distal esophageal spasm (DES), and esophagogastric junction outflow obstruction (EGJOO). 9The study by Patel et al. published in this issue of the journal is the first to evaluate functional lumen imaging probe (FLIP) findings in chronic opioid users compared to non-users. A total of 116 patients were evaluated including 33 chronic opioid users. Dysphagia was the most common symptom in both groups. Chronic opioid users exhibited significantly higher perceptive symptoms and worse quality of life compared to non-users while presenting esophageal symptoms were similar. There were significantly higher repetitive retrograde contractions (RRCs) in the chronic opioid users; however, only a

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