Major Finding: Patients referred for dysphagia related to long-term opioid therapy were significantly more likely to manifest spastic esophageal dysmotility disorders than were those not on opioids, as shown by high-resolution impedance manometry.
Data Source: Case series of 122 patients, 26 of whom were on long-term opioid therapy.
Disclosures: No disclosures were reported.
BOSTON – A retrospective study of dysphagic patients who underwent high-resolution impedance manometry found that spastic esophageal dysmotility was significantly more common in those on long-term opioid therapy than in those not taking opioids, said Dr. Kee Wook Jung, who presented the results as a poster at the meeting.
“Opioid esophageal dysmotility disorder represents a newly recognized disorder, and all patients undergoing esophageal manometry should be carefully questioned about the use of narcotics,” commented Dr. Jung, who is affiliated with the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn.
In this chart review of 122 patients who underwent high-resolution impedance manometry (HRIM) between July 2008 and February 2010, 26 patients were identified who underwent HRIM while on long-term opioid therapy. Of the 26 patients on opioids, 17 met diagnostic criteria for spastic esophageal dysmotility, compared with 35 of the 96 patients not taking opioids. The criteria included achalasia, diffuse esophageal spasm, nutcracker esophagus, and hypertensive lower esophageal sphincter (LES) pressure, Dr. Jung noted at the meeting, which was hosted by the American Neurogastroenterology and Motility Society.
Overall, the specific changes noted suggest that chronic opioid use impairs esophageal inhibitory innervation, according to Dr. Jung. For instance, compared with those not using opioids, those taking opioids had significantly higher resting LES pressure, higher amplitude of esophageal body at 10 cm above LES, longer duration of esophageal body contraction at 5 cm above LES, higher distal esophageal amplitude, and longer duration of distal esophageal contraction. Contraction velocity at 10 cm above LES was also faster in the opioid group.
Although the effects of opiates on the stomach, small intestine, and colon have been well studied, their effect on the esophagus is less well known. In a previously reported study using low-resolution conventional manometry (Aliment. Pharmacol. Ther. 2010;31:601-6), researchers from this group reported simultaneous and nonperistaltic contractions, as well as increased esophageal contraction velocity in those who used opioids. They also showed that for some patients, improvements could be documented after opioids were discontinued. The investigators concluded that esophageal manometric abnormalities seen in patients on long-term opiates were secondary to the medication, and not to a primary esophageal motility disorder.