The Effects of Chronic Opioid Therapy on Achalasia and the Upper Esophageal Sphincter

Background: The rise of opioid drug usage in the U.S. correlates with increasing recognition of gastrointestinal side effects, especially in the esophagus. The literature has recently noted that abnormalities in the upper esophageal sphincter (UES) are a poor prognostic factor in Achalasia treatment response. A better understanding of the relationship between opioid therapy and esophageal motility and sphincter function may shape our management guidelines for esophageal dysmotilities. This study aimed to evaluate dysmotility patterns, specifically UES function, among the veteran population, where opioid use is reportedly high. Methods: We performed a retrospective search of all the veterans at a large urban veteran affairs hospital who had undergone esophageal manometry from 2013 to 2022, collecting data on patient demographics, indication for procedure, diagnosis, sphincter pressure values, and presence of chronic opioid use. Results: Of 395 patients, 29% had a history of chronic opioid therapy. Notably, patients that were diagnosed with Achalasia had a greater proportion of chronic opioid use as compared to those who were not. Additionally, there was a statistically significant lower average upper esophageal resting pressure in opioid patients compared to non-opioid patients. Conclusions: Veteran patients with Achalasia have a greater proportion of chronic opioid use as compared to those without. There are significant manometric pressure differences at the upper esophageal sphincter among chronic opioid users when compared to non-opioid users.