The following is a summary of “Systematic Review With Meta-Analysis: Chronic Opioid Use Is Associated With Esophageal Dysmotility in Symptomatic Patients,” published in the December 2023 issue of Gastroenterology by Niu, et al.
For a systematic review and meta-analysis, researchers sought to evaluate the impact of chronic opioid exposure on esophageal motility in patients undergoing manometric evaluation.
Multiple databases were systematically searched until October 2022 for original studies comparing manometric results between patients with chronic opioid use (lasting >90 days) and those without. Primary outcomes focused on esophageal dysmotility disorders, while three high-resolution manometry parameters were considered as secondary outcomes. A random-effects model calculated odds ratios (OR) and mean differences (MD), accompanied by 95% CI.
Nine studies were included. Chronic opioid use was associated with higher rates of esophageal dysmotility disorders, specifically distal esophageal spasm (pooled OR 4.84, 95% CI 1.60–14.63, P = 0.005, I2 = 96%), esophagogastric junction outflow obstruction (pooled OR 5.13, 95% CI 2.11–12.43, P = 0.0003, I2 = 93%), and type III achalasia (pooled OR 4.15, 95% CI 2.15–8.03, P < 0.0001, I2 = 64%). No significant differences were observed for hypercontractile esophagus, type I achalasia, or type II achalasia. Notably, basal lower esophageal sphincter pressure (MD 3.02, 95% CI 1.55–4.50, P < 0.0001, I2 = 90%), integrated relaxation pressure (MD 2.51, 95% CI 1.56–3.46, P < 0.00001, I2 = 99%), and distal contractile integral (MD 640.29, 95% CI 469.56–811.03, P < 0.00001, I2 = 91%) significantly differed between the opioid and nonopioid groups. However, chronic opioid use was associated with a lower risk of ineffective esophageal motility (pooled OR 0.68, 95% CI 0.49–0.95, P = 0.02, I2 = 53%).
The meta-analysis underscored that chronic opioid exposure was linked to an increased occurrence of esophageal dysmotility disorders. Specifically, the study highlighted a significant association between opioid use and type III achalasia, emphasizing the consideration of opioid treatment as a potential underlying risk factor in the diagnosis of major esophageal motor abnormalities.
Source: journals.lww.com/ajg/abstract/2023/12000/systematic_review_with_meta_analysis__chronic.13.aspx
