Opioid-induced esophageal dysfunction (OIED) is more prevalent with the use of oxycodone or hydrocodone than with tramadol, according to a study published in The American Journal of Gastroenterology. Furthermore, the likelihood of developing OIED is increased with higher doses.
In this retrospective review, researchers queried a prospectively maintained esophageal manometry database to identify chronic opioid users who underwent high-resolution manometry (HRM) between January 2012 and January 2018 (N=225). Patients had taken opioids for ≥3 months before HRM, including oxycodone (n=68), hydrocodone (n=97), and tramadol (n=60). OIED was defined by the presence of esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), achalasia type III, or jackhammer esophagus (JE).
The most common diagnoses in chronic opioid users with OIED were DES in 49%, EGJOO in 43%, JE in 24%, and achalasia type III in 2%. There was a significant increase in OIED in patients whose last opioid dose was ≤24 hours before the HRM procedure, compared with patients whose last dose was ≥24 hours before HRM (33% vs 15%; P =.004). OIED was significantly more prevalent with the use of oxycodone or hydrocodone than with tramadol (31% vs 28% vs 12%; P =.016). OIED was also more prevalent for oxycodone alone compared with oxycodone with acetaminophen (43% vs 21%; P =.048).
Limitations of this study include those inherent in retrospective studies, which can include effects from confounding factors. To address the potential for confounding effects, a substantial number of patients with chronic opioid prescriptions and esophageal surgeries or procedures were excluded to maintain equivalent baseline demographics. Due to the nature of the study, the results represent that causal relationships between OIED and opioid use cannot be determined.
“How to treat patients with OIED is not entirely clear, and multiple questions remain including whether these patients have a similar clinical course and response to treatment as those with esophageal dysfunction not taking chronic opioids,” the researchers concluded. “Based on our results, we would recommend opioid cessation as the first management strategy to consider when treating OIED. If this is not feasible, the next approach would be to reduce the opioid to the least effective dose or change to a less potent type such as tramadol.”
Snyder DL, Crowell MD, Horsley-Silva J, Ravi K, Lacy BE, Vela MF. Opioid-induced esophageal dysfunction: differential effects of type and dose. Am J Gastroenterol. 2019;114(9):1464-1469.