Dysphagia occurs in nearly 2 of 3 individuals receiving treatment with opioids and undergoing high-resolution manometry (HRM), and more than a quarter are diagnosed with hypercontractile esophagus or distal esophageal spasm, according to study results published in Gastroenterology.
Previous studies have used a small sample size to examine the association between chronic opioid use and esophageal motility disorders. For the current study, researchers used a large cohort of 4075 individuals (women, 64%; median age, 61 [IQR, 50-71] years; chronic opioid use, 21%), recruited from a tertiary medical facility. All patients underwent HRM from 2007 to 2018. Researchers compared patients’ clinical symptoms, demographic characteristics, HRM parameters, and opioid exposure. Both Eckardt score and Patient-Reported Outcomes Measurement Information System-Gastrointestinal swallowing domain (PROMIS-GI swallowing domain) were administered via phone interviews to determine long-term symptom burden among opioid users vs opioid nonusers with hypercontractile esophagus or distal esophageal spasm.
Opioid users vs opioid nonusers were significantly more likely to have a diagnosis of dysphagia (65% vs 51%; P <.01) as well as hypercontractile esophagus (9% vs 3%; P <.01) and distal esophageal spasm (11% vs 5%; P <.01). Motility abnormalities did not vary significantly with partial opioid agonist use. Following manometric diagnosis, symptom burden was significantly higher among opioid users vs opioid nonusers over a median 8.9 years of follow-up. The median PROMIS-GI swallowing domain score for opioid users vs opioid nonusers was 21.5 (IQR, 17-25) vs 15 (IQR, 9.8-21; P =.03).
The study is limited by its retrospective cohort design.
“More than 1 in 4 patients with dysphagia and on opioids had a diagnosis of either DES [distal esophageal spasm] or hypercontractile esophagus,” the study authors wrote. “Type of opioid, age, and MME [morphine milligram equivalent] may predict risk of abnormal manometric diagnosis in this group of patients. Patients on opioids with spastic motor disorders have higher long-term symptom burden compared with nonopioid users.”
This article originally appeared on Gastroenterology Advisor
Patel DA, Goss J, Hayat M, et al. Opioid exposure differentially impacts esophageal body contraction over the lower esophageal sphincter. Gastroenterol. 2022;163(2):403-410. doi:10.1053/j.gastro.202