Assessing the Effects of Opioids on the Esophagus

More than 191 million opioid prescriptions were dispensed in the US in 2017 and the numbers continue to rise. Previously data showed that opioids affect the ability of the lower esophageal sphincter muscle to relax after a swallow. Spastic contractions are more likely in patients on chronic opioids. Opioids may create abnormalities that mimic esophageal motility disorders such as achalasia. Given the large number of patients on chronic opioids it is important to understand the effects of opioids on the esophagus. Objective 1: To assess the differences in esophageal motility diagnoses in patients on chronic opioids versus a matched cohort of patients not on chronic opioids. We hypothesize that patients on chronic narcotics at the time of high-resolution manometry compared to matched cohort controls will be more likely to have type III achalasia and esophagogastric junction outflow obstruction on high resolution manometry. Objective 2: To assess dysphagia and reflux symptom rates in chronic opioid users. We hypothesize that patients on chronic narcotics will have higher rates of reflux and dysphagia symptoms than the general population. Objective 3: To assess the esophageal motility characteristics and diagnosis among patients on chronic opioids that do not have esophageal symptoms. We hypothesize that asymptomatic patients on chronic narcotics (patient controls) will have abnormal findings on high-resolution manometry.Study 1: An EDW query will be performed to identify patients that were on opioids for at least 3 months prior to their high-resolution manometry. We will evaluate demographic, clinical and manometric data and compare to a matched-cohort for non-opioid users. We will evaluate morphine equivalent dosing as a variable of interest. High resolution manometry data will be classified according to The Chicago classification of esophageal motility disorders v3.0 [10] Demographic and manometric data will be compared between the two groups (opioid and non-op