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Area of Science:

  • Gastroenterology
  • Pharmacology
  • Esophageal Motility Disorders

Background:

  • Chronic opioid use is prevalent and associated with various adverse effects.
  • Opioid-induced esophageal dysfunction (OIED) is an emerging complication affecting esophageal motility.
  • Understanding OIED is crucial for managing patients on long-term opioid therapy.

Purpose of the Study:

  • To review the pathophysiology, diagnosis, and management of opioid-induced esophageal dysfunction (OIED).
  • To elucidate the mechanisms by which opioids affect esophageal function.
  • To highlight diagnostic criteria and current management strategies for OIED.

Main Methods:

  • Literature review of studies on opioid use and esophageal motility.
  • Analysis of manometric findings in patients with suspected OIED.
  • Correlation of OIED prevalence with opioid type, dose, and duration.

Main Results:

  • OIED is diagnosed via symptoms, opioid history, and manometric findings (e.g., distal esophageal spasm, EGJIO, achalasia type III, jackhammer esophagus).
  • Opioids disrupt esophageal inhibitory signals, leading to spastic contractility and impaired relaxation.
  • Higher doses and stronger opioids (oxycodone, hydrocodone) are associated with increased OIED prevalence compared to weaker opioids (tramadol).
  • Reduced deglutitive inhibition during manometry confirms impaired signaling in opioid users.

Conclusions:

  • OIED is common in chronic opioid users, particularly with higher doses or potent opioids.
  • Impaired esophageal inhibitory signaling is the likely mechanism behind OIED.
  • Opioid cessation or dose reduction is recommended, though specific management studies are limited.