Chronic Opioid Exposure Can Lead to a Higher Likelihood of Hypercontractile Esophagus and Distal Esophageal Spasm
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Chronic Opioid Exposure Can Lead to a Higher Likelihood of Hypercontractile Esophagus and Distal Esophageal Spasm

Prateek Sharma, MD, FASGE, reviewing Patel DA, et al. Gastroenterology 2022 Aug.

Given a major increase (50%) in opioid prescriptions across the United States from 2000 to 2010, there is renewed interest in evaluating the effects of opioids on the esophagus and esophageal motility.

From a cohort of 4075 patients who received high-resolution manometry (HRM) between 2007 and 2018, the authors collected information on opioid exposure, symptoms, HRM parameters, Patient-Reported Outcomes Measurement Information System (PROMIS)-GI swallowing domain scores, and Eckardt scores. 

Of all the patients, 869 had opioid exposure with a median morphine milligram equivalent of 30. When compared with patients not exposed to opioids, patients in the opioid group were significantly more likely to have dysphagia (65% vs 51%; P<.01), a diagnosis of distal esophageal spasm (DES; 11% vs 5%; P<.01), and hypercontractile esophagus (HE; 9% vs 3%; P<.01). Furthermore, over a median follow-up of 8.9 years (5.8-10.4) after diagnosis, these patients had a significantly higher symptom burden, with a median PROMIS-GI swallowing domain score of 21.5 (17-25) compared with the nonopioid group at 15 (9.8-21; P<.03). However, partial opioid agonists were not associated with motility abnormalities.

Prateek Sharma, MD, FASGE

COMMENT

Nearly two-thirds of patients exposed to opioids who undergo HRM have dysphagia. Opioid exposure is associated with DES and HE (1 in 4 patients) but not type III achalasia or esophagogastric junction outflow obstruction. Compared with nonopioid users, patients with spastic motor disorders and opioid exposure have a higher long-term symptom burden. However, unlike full opioid agonists, partial opioid agonists are not associated with motility abnormalities.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Patel DA, Goss J, Hayat M, et al. Opioid exposure differentially impacts esophageal body contraction over the lower esophageal sphincter. Gastroenterology 2022;163:403-410. (https://doi.org/10.1053/j.gastro.2022.04.051)

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