Opioid Use Associated With Distal Esophageal Spasm and Hypercontractile Esophagus

Researchers sought to determine the effect of long-term opioid exposure on esophageal motility, using a large cohort.

Dysphagia occurs in nearly 2 of 3 individuals receiving treatment with opioids and undergoing high-resolution manometry (HRM), and more than a quarter are diagnosed with hypercontractile esophagus or distal esophageal spasm, according to study results published in Gastroenterology.

Previous studies have used a small sample size to examine the association between chronic opioid use and esophageal motility disorders. For the current study, researchers used a large cohort of 4075 individuals (women, 64%; median age, 61 [IQR, 50-71] years; chronic opioid use, 21%), recruited from a tertiary medical facility. All patients underwent HRM from 2007 to 2018. Researchers compared patients’ clinical symptoms, demographic characteristics, HRM parameters, and opioid exposure. Both Eckardt score and Patient-Reported Outcomes Measurement Information System-Gastrointestinal swallowing domain (PROMIS-GI swallowing domain) were administered via phone interviews to determine long-term symptom burden among opioid users vs opioid nonusers with hypercontractile esophagus or distal esophageal spasm.

Opioid users vs opioid nonusers were significantly more likely to have a diagnosis of dysphagia (65% vs 51%; P <.01) as well as hypercontractile esophagus (9% vs 3%; P <.01) and distal esophageal spasm (11% vs 5%; P <.01). Motility abnormalities did not vary significantly with partial opioid agonist use. Following manometric diagnosis, symptom burden was significantly higher among opioid users vs opioid nonusers over a median 8.9 years of follow-up. The median PROMIS-GI swallowing domain score for opioid users vs opioid nonusers was 21.5 (IQR, 17-25) vs 15 (IQR, 9.8-21; P =.03).

The study is limited by its retrospective cohort design.

“More than 1 in 4 patients with dysphagia and on opioids had a diagnosis of either DES [distal esophageal spasm] or hypercontractile esophagus,” the study authors wrote. “Type of opioid, age, and MME [morphine milligram equivalent] may predict risk of abnormal manometric diagnosis in this group of patients. Patients on opioids with spastic motor disorders have higher long-term symptom burden compared with nonopioid users.”


Patel DA, Goss J, Hayat M, et al. Opioid exposure differentially impacts esophageal body contraction over the lower esophageal sphincter. Gastroenterol. 2022;163(2):403-410. doi:10.1053/j.gastro.202