Effects of codeine on esophageal peristalsis in humans using high resolution manometry

Chen, Chien‐Lin; Wong, Ming‐Wun; Hung, Jui‐Sheng; Liang, Shu-Wei; Liu, Tso‐Tsai; Yi, Chih‐Hsun; Lin, Lin; Orr, William C.; Lei, Wei‐Yi

doi:10.1111/jgh.15641

Cited by 3 publications

(7 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We chose to study weak opioids due to their well‐documented side‐effects of constipation 30 and their common usage in the UK. 7 There is also evidence of a direct effect of codeine on oesophageal peristalsis, 12 gastric emptying 13 and colonic transit 14 in human studies. In support of this we observed an exposure response, and we observed an increased risk of gastric cancer in weak opioid users compared with ibuprofen users (who may share indications).…”

Section: Discussionmentioning

confidence: 99%

“…9 Opioids bind to mu receptors in the GI tract and decrease motility by inhibiting cholinergic neurotransmission, 10 and constipation is a well-documented sideeffect in primary care. 11 Codeine has been shown in human studies to decrease oesophageal peristalsis, 12 delay gastric emptying 13 and increase colonic transit time. 14 To date, there has not been a study that has investigated the effect of weak opioids on risk of developing GI malignancy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exposure to weak opioids and risk of gastrointestinal tract cancers: A series of nested case‐control studies

Houston

McMenamin

Johnston

et al. 2023

Brit J Clinical Pharma

View full text Add to dashboard Cite

AimsThere is evidence gastrointestinal (GI) motility may play a role in the development of GI cancers. Weak opioids (codeine and dihydrocodeine) decrease GI motility, but their effect on GI cancer risk has not been assessed. We aim to assess the association between weak opioids and cancers of the GI tract.MethodsA series of nested case‐control studies was conducted using Scottish general practice records from the Primary Care Clinical Informatics Unit Research database. Oesophageal (n = 2432), gastric (n = 1443) and colorectal cancer (n = 8750) cases, diagnosed between 1999 and 2011, were identified and matched with up to five controls. Weak opioid use was identified from prescribing records. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression, adjusting for relevant comorbidities and medication use.ResultsThere was no association between weak opioids and colorectal cancer (adjusted OR = 0.96, CI 0.90, 1.02, P = 0.15). There was an increased risk of oesophageal (adjusted OR = 1.16, CI 1.04, 1.29, P = 0.01) and gastric cancer (adjusted OR = 1.26, CI 1.10, 1.45, P = 0.001). The associations for oesophageal cancer, but not gastric cancer, were attenuated when weak opioid users were compared with users of another analgesic (adjusted OR = 1.03 CI 0.86, 1.22, P = 0.76 and adjusted OR = 1.29 CI 1.02, 1.64, P = 0.04 respectively).ConclusionsIn this large population‐based study, there was no consistent evidence of an association between weak opioids and oesophageal or colorectal cancer risk, but a small increased risk of gastric cancer. Further investigation is required to determine whether this association is causal or reflects residual confounding or confounding by indication.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exposure to weak opioids and risk of gastrointestinal tract cancers: A series of nested case‐control studies

Houston

McMenamin

Johnston

et al. 2023

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…Oral administration of 60 mg of codeine or the placebo 45 minutes prior to HRM studies were performed in a random order, as previously reported. 17 The crossover design of the study is shown in Figure 1 . Primary peristalsis was evaluated using 10 swallows of 5-mL of saline; each swallow was spaced 20 seconds apart.…”

Section: Methodsmentioning

confidence: 99%

“…Due to earlier work revealing significant differences in DL and IRP-4s of primary peristalsis and frequency of secondary peristalsis, 17 the estimated number of cases was estimated as at least 14 to achieve a power of 80% and α of 0.05. Differences between codeine and the placebo were compared using a paired test and represented as mean ± SEM.…”

Section: Methodsmentioning

confidence: 99%

“… 8 , 16 Recently, our group demonstrated that acute administration of codeine affects both primary and secondary peristalsis in healthy volunteers. 17 However, little is known about the effects of acute administration of opioids on esophageal manometric findings in IEM patients. Therefore, we aim to determine the effects of acute codeine administration on primary and secondary esophageal peristalsis assessed by high-resolution manometry (HRM) in IEM patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Codeine on Esophageal Peristalsis in Patients With Ineffective Esophageal Motility: Studies Using High-resolution Manometry

Lei,

Liu,

Chang

et al. 2024

J Neurogastroenterol Motil

Self Cite

View full text Add to dashboard Cite

Background/Aims This study aims to evaluate the effects of acute codeine administration on primary and secondary esophageal peristalsis in patients with ineffective esophageal motility (IEM). Methods Eighteen IEM patients (8 women; mean age 37.8 years, range 23-64 years) were enrolled in the study. The patients underwent high-resolution manometry exams, consisting of 10 single wet swallows, multiple rapid swallows, and ten 20 mL rapid air injections to trigger secondary peristalsis. All participants completed 2 separate sessions, including acute administration of codeine (60 mg) and placebo, in a randomized order. Results Codeine significantly increased the distal contractile integral (566 ± 81 mmHg∙s∙cm vs 247 ± 36 mmHg∙s∙cm, P = 0.001) and shortened distal latency (5.7 ± 0.2 seconds vs 6.5 ± 0.1 seconds, P < 0.001) for primary peristalsis compared with these parameters after placebo treatment. The mean total break length decreased significantly after codeine treatment compared with the length after placebo ( P = 0.003). Codeine significantly increased esophagogastric junction-contractile integral ( P = 0.028) but did not change the 4-second integrated relaxation pressure ( P = 0.794). Codeine significantly decreased the frequency of weak ( P = 0.039) and failed contractions ( P = 0.009), resulting in increased frequency of normal primary peristalsis ( P < 0.136). No significant differences in the ratio of impaired multiple rapid swallows inhibition and parameters of secondary peristalsis were detected. Conclusions In IEM patients, acute administration of codeine increases contraction vigor and reduces distal latency of primary esophageal peristalsis, but has no effect on secondary peristalsis. Future studies are required to further elucidate clinical relevance of these findings, especially in the setting of gastroesophageal reflux disease with IEM.

show abstract

Effects of capsaicin on esophageal peristalsis in humans using high resolution manometry

Lei,

Hung,

Wong

et al. 2024

Neurogastroenterology Motil

View full text Add to dashboard Cite

BackgroundCapsaicin‐containing red pepper sauce suspension augments esophageal contraction amplitude on conventional manometry. This study used high‐resolution manometry (HRM) to investigate if capsaicin infusion modulates segmental esophageal smooth muscle peristalsis in healthy adults.MethodsSixteen healthy volunteers (mean age 37 years, 14 male) underwent HRM for the evaluation of primary peristalsis and secondary peristalsis using slow and rapid air distensions. Both primary and secondary peristalsis were assessed following infusions of capsaicin‐containing red pepper sauce and saline.Key ResultsCapsaicin infusion significantly increased heartburn symptoms compared to saline infusion (p < 0.001), and significantly decreased threshold volumes of secondary peristalsis during rapid air distensions (p = 0.02). The frequency of secondary peristalsis during rapid air distensions was significantly increased by capsaicin infusion (p = 0.03). Neither capsaicin infusion (p = 0.06) nor saline infusion (p = 0.27) altered threshold volume during slow air distensions. Capsaicin infusion significantly increased distal contractile integral (DCI) of primary peristalsis (p = 0.04), particularly in the proximal smooth muscle segment (p = 0.048). It enhanced secondary peristalsis during rapid air distensions (p = 0.003) but not during slow air distension (p = 0.23). Saline infusion significantly increased DCI of secondary peristalsis during rapid air distension (p = 0.01).Conclusions and InferencesAugmentation of distension‐induced secondary peristalsis can be modulated by activation of capsaicin‐sensitive afferents similar to mechanosensitive afferents. Capsaicin‐induced augmentation of primary peristalsis isolates to the cholinergic‐mediated proximal smooth muscle segment, which warrants study in ineffective esophageal motility to determine therapeutic potential.

show abstract

Effects of codeine on esophageal peristalsis in humans using high resolution manometry

Cited by 3 publications

References 33 publications

Exposure to weak opioids and risk of gastrointestinal tract cancers: A series of nested case‐control studies

Exposure to weak opioids and risk of gastrointestinal tract cancers: A series of nested case‐control studies

Effects of Codeine on Esophageal Peristalsis in Patients With Ineffective Esophageal Motility: Studies Using High-resolution Manometry

Effects of capsaicin on esophageal peristalsis in humans using high resolution manometry

Contact Info

Product

Resources

About