Impact of opioids on esophageal motility

Abstract

United States (US) and this will likely increase as the population continues to age. Chronic opioids are prescribed to 3%-4% of the US population with a rise in opioid related deaths to more than 440,000 between 1999 and 2018. 1 Prescription opioid use in Europe has also increased over the last decade, but the subsequent harms are less well defined. 2 Chronic opioid use increases risk for abuse, dependence, and overdose. In response to the opioid epidemic, the Centers for Disease Control and Prevention (CDC) released guidelines in 2016 to advise US medical providers on safe practices for prescribing opioids with a recent update last year. 3,4 Opioids are also known to cause adverse effects in the gastrointestinal tract including gastroparesis symptoms such as nausea and vomiting as well as constipation. [5][6][7] The effects of opioids on esophageal function are less understood, but increasing in recognition. [5][6][7][8] Recently, opioidinduced esophageal dysfunction (OIED) has been described as a clinical syndrome defined by chronic opioid use (≥3 months), esophageal symptoms, and esophageal motility abnormalities diagnosed by manometry including achalasia type III, hypercontractile esophagus, distal esophageal spasm (DES), and esophagogastric junction outflow obstruction (EGJOO). 9The study by Patel et al. published in this issue of the journal is the first to evaluate functional lumen imaging probe (FLIP) findings in chronic opioid users compared to non-users. A total of 116 patients were evaluated including 33 chronic opioid users. Dysphagia was the most common symptom in both groups. Chronic opioid users exhibited significantly higher perceptive symptoms and worse quality of life compared to non-users while presenting esophageal symptoms were similar. There were significantly higher repetitive retrograde contractions (RRCs) in the chronic opioid users; however, only a