Incidence of opioid-induced esophageal dysfunction

Abstract

Background

Retrospective studies have suggested that long-term use of opioids can cause esophageal motility dysfunction. A recent clinical entity known as opioid-induced esophageal dysfunction (OIED) has been postulated. There is no data from prospective studies assessing the incidence of opioid-induced effects on the esophagus.

Aim

Evaluate the incidence of OIED during chronic opioid therapy.

Methods

From February 2017 to August 2018, all patients seen in the Pain Unit of the hospital, who started opioid treatment for chronic non-neoplastic pain and who did not present esophageal symptoms previously, were included. The presence of esophageal symptoms was assessed using the Eckardt score after 3 months and 1 year since the start of the study. In February 2021, the clinical records of all included patients were reviewed to assess whether esophageal symptoms were present and whether opioid therapy was continued. In patients presenting with esophageal symptoms, an endoscopy was performed and, if normal, a high-resolution esophageal manometry was performed. For a confidence level of 95%, a 4% margin of error and an estimated prevalence of 4%, a sample size of 92 patients was calculated.

Results

100 patients were included and followed while taking opioids, for a median of 31 months with a range between 4 and 48 months. Three women presented with dysphagia during the first 3 months of treatment, being diagnosed with esophagogastric junction outflow obstruction; type II and type III achalasia. The cumulative incidence of OIED was 3%; 95%-CI: 0–6%.

Conclusions

Chronic opioid therapy in patients with chronic non-neoplastic pain is associated with symptomatic esophageal dysfunction.

Resumen

Antecedentes

Estudios retrospectivos han sugerido que el uso crónico de opiáceos puede causar disfunción esofágica. Se ha postulado una entidad clínica reciente denominada disfunción esofágica inducida por opioides (DEIO). No existen estudios prospectivos que evalúen la incidencia de esta entidad.

Objetivo

Evaluar la incidencia de DEIO durante el tratamiento crónico con opiáceos.

Métodos

Desde febrero de 2017 hasta agosto de 2018, se incluyeron todos los pacientes atendidos en la Unidad del Dolor de nuestro hospital, que iniciaron opiáceos por dolor crónico no neoplásico sin síntomas esofágicos previos. La clínica esofágica se valoró mediante la escala de Eckardt a los tres meses y al año. En febrero de 2021, se revisaron las historias clínicas de todos los pacientes para evaluar la presencia de clínica esofágica y si continuaban con opiáceos. En los pacientes con síntomas esofágicos, se realizó una gastroscopia y, si era normal, una manometría esofágica de alta resolución. Para un nivel de confianza del 95%, una precisión del 4% y una prevalencia estimada del 4%, se calculó un tamaño muestral de 92 pacientes.

Resultados

Se incluyeron 100 pacientes que fueron seguidos mientras tomaban opiáceos, con una mediana de 31 meses y un rango entre 4 y 48 meses. Tres mujeres presentaron un trastorno motor esofágico durante el seguimiento (obstrucción funcional de la unión esofagogástrica; acalasia tipo II y tipo III). La incidencia acumulada fue del 3%; IC 95%: 0-6%.

Conclusiones

El tratamiento crónico con opiáceos en pacientes con dolor crónico no neoplásico se asocia a disfunción esofágica sintomática.