Chronic Opioid Exposure Can Lead to a Higher Likelihood of Hypercontractile Esophagus and Distal Esophageal Spasm

Given a major increase (50%) in opioid prescriptions across the United States from 2000 to 2010, there is renewed interest in evaluating the effects of opioids on the esophagus and esophageal motility.

From a cohort of 4075 patients who received high-resolution manometry (HRM) between 2007 and 2018, the authors collected information on opioid exposure, symptoms, HRM parameters, Patient-Reported Outcomes Measurement Information System (PROMIS)-GI swallowing domain scores, and Eckardt scores. 

Of all the patients, 869 had opioid exposure with a median morphine milligram equivalent of 30. When compared with patients not exposed to opioids, patients in the opioid group were significantly more likely to have dysphagia (65% vs 51%; P<.01), a diagnosis of distal esophageal spasm (DES; 11% vs 5%; P<.01), and hypercontractile esophagus (HE; 9% vs 3%; P<.01). Furthermore, over a median follow-up of 8.9 years (5.8-10.4) after diagnosis, these patients had a significantly higher symptom burden, with a median PROMIS-GI swallowing domain score of 21.5 (17-25) compared with the nonopioid group at 15 (9.8-21; P<.03). However, partial opioid agonists were not associated with motility abnormalities.