The key to improving esophageal dysmotility may be in limiting or even eliminating opioid consumption among patients, Chengu Niu, MD, said during his abstract presentation at the Digestive Disease Week (DDW) 2023 in Chicago.

Dr Niu is a doctor of internal medicine at the Rochester General Hospital, Rochester, New York.

“The chronic use of opioids has dramatically increased in the United States, and it is crucial to understand how opioids may impact esophageal motility from both patient care and public health perspectives,” Dr Niu addressed the audience on the association between chronic opioid consumption and esophageal motility disorders.

Through a systematic review and meta-analysis of multiple major databases till September 2022, the researchers compared the primary outcomes of esophageal dysmotility disorders, including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypercontractile esophagus, and achalasia, between patients who used opioids vs those who did not. The secondary outcomes were listed as high-resolution manometry (HRM) parameters including basal lower esophageal sphincter (LES) pressure, integrated relaxation pressure (IRP) and distal contractile integral.

The study included 9,979 patients—8,246 (82.6%) patients were enrolled in non-opioid use cohort and 1,733 (17.4%) patients in the opioid use cohort. They found that patients who used opioids were associated with higher esophageal dysmotility disorders, including DES (OR 5.09; 95% CI 1.75 – 14.81); EGJOO (OR 5.13; 95% CI 2.11 – 12.43), and type III achalasia (OR 4.15; 95% CI 2.15 – 8.03).

However, no statistically significant difference was observed in the hypercontractile esophagus (OR 1.87; 95% CI 0.69 – 5.03), type I achalasia (OR 1.01; 95% CI 0.56 – 1.84) or type II achalasia (OR 0.90; 95% CI 0.57 – 1.42).

“The basal LES pressure (mean difference, 3.12; 95% CI), IRP (mean difference, 1.77; 95% CI), and distal contractile integral (mean difference, 574.39; 95% CI) significantly differed between opioid use and non-opioid use group,” Dr Niu said.

Opioids have been long known to cause severe effects on the gastrointestinal tract including nausea, vomiting, and constipation. Up until now, there was limited data on the effects of opioids on the esophagus. The recent study by Dr Niu et colleagues proved that “opioid treatment should be taken into account as a potential underlying etiology when diagnosing these major esophageal motor abnormalities.” And while more research is required, it is suggested that eliminating opioids may improve esophageal dysmotility.

—Priyam Vora

Reference:
Niu C. Presentation #EP55: Chronic opioid use is associated with esophageal dysmotility: A systematic review and meta-analysis. Digestive Disease Week 2023. Chicago, Illinois.