Opioids Interfere With Deglutitive Inhibition Assessed by Response to Multiple Rapid Swallows During High-Resolution Esophageal Manometry

Snyder, Diana L.; Valdovinos, Luís Renter; Horsley‐Silva, Jennifer L.; Crowell, Michael D.; Valdovinos, Miguel A.; Vela, Marcelo F.

doi:10.14309/ajg.0000000000000682

Cited by 13 publications

(38 citation statements)

References 11 publications

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“…This excitatory-inhibitory "imbalance" would induce spastic motor disorders of distal esophagus including the reduced latency as seen in DES and impaired LES relaxation seen in EGJOO. 26,27 The current findings illustrate the inhibitory effect of codeine on esophageal primary peristalsis, which is similar to that reported in previous studies. 15,23,[26][27][28] Figure 1 Effects of codeine on 4-s integrated relaxation pressure (IRP-4s) of primary esophageal peristalsis.…”

Section: Discussionsupporting

confidence: 91%

“…Recent studies utilizing HRM have shown that opioids use increased LES pressure and is associated with hypercontractility. 15,23,[26][27][28] A large sample size series conducted by Ratuapli et al 15 further demonstrated an association between chronic opioid use and esophageal motor dysfunction. They found that the main opioid-related esophageal disorders are EGJOO and type III achalasia, and the other dysmotility described are distal esophageal spasm (DES) and hypercontractile esophagus, a clinical entity which has been termed opioid-induced esophageal dysfunction (OIED).…”

Section: Discussionmentioning

confidence: 98%

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

Chen

Wong

Hung

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Opioid receptors agonists have been demonstrated to impair lower esophageal sphincter (LES) relaxation and induce spastic esophageal dysmotility, but little was known for their impact on distension-induced secondary peristalsis. The aim of the study was to investigate the hypothesis whether acute administration of codeine can influence physiological characteristics of primary and secondary peristalsis in healthy adults. Methods: Eighteen healthy volunteers (13 men, mean age 27.5 years, aged 20-43 years) underwent high resolution manometry (HRM) with a catheter containing an injection port in mid-esophagus. Secondary peristalsis was performed with 10 and 20 mL rapid air injections. Two different sessions including acute administration of codeine (60 mg) or the placebo were randomly performed. Results: Codeine significantly increased 4-s integrated relaxation pressure (IRP-4s) (P = 0.003) and shortened distal latency (DL) (P = 0.003) of primary peristalsis. The IRP-4s of secondary peristalsis was also significantly higher after codeine than the placebo during air injections with 10 mL (P = 0.048) and 20 mL (P = 0.047). Codeine significantly increased the frequency of secondary peristalsis during air injections with 10 mL than the placebo (P = 0.007), but not for air injection with 20 mL (P = 0.305). Conclusions: In addition to impair LES relaxation and reduce distal latency of primary peristalsis, codeine impairs LES relaxation of secondary peristalsis and increases secondary peristaltic frequency. Our study supports the notion in human esophagus that the impact of opioids on peristaltic physiology appears to be present in both primary and secondary peristalsis.* P-value < 0.05 was considered statistically significant.Data are shown as the mean ± standard errors of the mean. DCI, distal contractile integral; DL, distal latency; IRP-4s, 4-s integrated relaxation pressure; SE, standard error of mean.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

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

Chen

Wong

Hung

et al. 2021

J of Gastro and Hepatol

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“…10 More recently, the same research group reported that chronic opioid use affects deglutitive inhibition of the esophageal body during the multiple rapid swallows (MRS), a provocative maneuver during HRM. 11 Furthermore, little is known about the effects of opioids in the proximal region of the esophagus, the upper esophageal sphincter (UES), and the pharynx. Smiley et al noted in a case study a decreased or absent swallowing function and gag reflex as a rare, but repetitive symptom after administration of the opioid fentanyl in healthy pregnant women during labor.…”

Section: Introductionmentioning

confidence: 99%

“…Median values (interquartile range) for esophageal pressure flow analysis neural pathways which results in abnormal contractile activity during MRS 11. Additionally, this study was the first to unravel the effect of a non-prescription opioid on the esophagus using PFA, which combines contractile activity and bolus flow.…”

mentioning

confidence: 97%

Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double‐blind, placebo‐controlled, cross‐over trial

Geeraerts

Geysen

Ballet³

et al. 2020

Neurogastroenterology Motil

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Background: Chronic opioid use can induce esophageal dysfunction with symptoms resembling achalasia and a manometric pattern of esophagogastric junction-outflow obstruction (EGJ-OO). However, the effect of opioids in acute setting on pharyngeal function and esophageal body contractility has not been investigated. Methods: After positioning the high-resolution impedance manometry (HRiM) catheter, codeine (60 mg) or placebo (glucose syrup) was infused intragastrically. Fortyfive minutes post-infusion, participants received liquid, semi-solid, and solid boluses to assess esophageal and pharyngeal function. HRiM analysis was performed adhering to the Chicago classification v3.0. (CC v3.0). Pressure flow analysis (PFA) for the esophageal body and the pharynx was performed using the SwallowGateway™ online platform. Key Results: Nineteen healthy volunteers (HV) [5 male; age 38.3] were included. After codeine administration, higher integrated relaxation pressure 4 s values resulted in significantly reduced deglutitive EGJ relaxation and distal latency was significantly shorter. Distal contractility was similar in both conditions. Bolus flow resistance at the EGJ and distention pressures increased significantly after codeine infusion. Based on CC v3.0, acute infusion of codeine induced EGJ-OO in six HV (p = 0.0003 vs. placebo).Codeine administration induced no significant alterations in any of the pharyngeal PFA metrics. Conclusions & Inferences:In HV, acute administration of codeine increased bolus resistance at the EGJ secondary to induced incomplete EGJ relaxation leading to major motility disorders in a subset of subjects including EGJ-OO. However, an acute single

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“…There is limited data to explain the pathophysiologic mechanisms of OIED, but the proposed mechanism is that chronic opioids interfere with inhibitory neural signaling leading to unregulated excitatory control in the esophagus. 6-9…”

Section: Opioid-induced Esophageal Dysfunction (Oied)mentioning

confidence: 99%

The Impact of Medications on Esophageal Motility

Snyder

Ravi

2021

Foregut: The Journal of the American Foregut Society

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The purpose of this review is to highlight the impact of common medications on esophageal motility. Esophageal motility is mediated through a complex network of neural innervation. Opioids lead to excitatory esophageal motor abnormalities termed opioid-induced esophageal dysfunction or OIED. Prokinetics have mixed effects on esophageal motility. Nitrates and calcium channel blockers relax esophageal smooth muscle, but they are limited clinically due to side effects. Sildenafil also relaxes smooth muscle, but it is costly. Peppermint oil may reduce distal esophageal spasm. Anticholinergics, selective serotonin reuptake inhibitors, estrogen, and cannabis need further study to evaluate their effects on esophageal motility.

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Opioids Interfere With Deglutitive Inhibition Assessed by Response to Multiple Rapid Swallows During High-Resolution Esophageal Manometry

Cited by 13 publications

References 11 publications

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

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

Codeine induces increased resistance at the esophagogastric junction but has no effect on motility and bolus flow in the pharynx and upper esophageal sphincter in healthy volunteers: A randomized, double‐blind, placebo‐controlled, cross‐over trial

The Impact of Medications on Esophageal Motility

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