It has previously been demonstrated that there is an association between chronic opioid use and esophageal motor dysfunction characterized by esophagogastric junction outflow obstruction, distal esophageal spasm, achalasia III and possibly jackhammer esophagus. To characterize the influence of different opioids and doses on esophageal dysfunction, a retrospective review of 225 patients prescribed oxycodone, hydrocodone, or tramadol for greater than 3 months and who completed high-resolution manometry from 2012 to 2017 was carried out.

Demographic and manometric data were extracted from a prospectively maintained motility database. Frequency of opioid-induced esophageal dysfunction (OIED), defined as distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III or jackhammer esophagus on high-resolution manometry, was compared among different opioids. The total 24-hour opioid doses for oxycodone, hydrocodone, and tramadol were converted to a morphine equivalent for dose effect analysis.

OIED was present in 24% (55 of 225) of opioid users. OIED was significantly more prevalent with oxycodone or hydrocodone use, compared with tramadol (31% vs. 28% vs. 12%), and for oxycodone alone vs. oxycodone with acetaminophen (43% vs. 21%), there was no difference in OIED for patients taking hydrocodone alone vs. hydrocodone with acetaminophen. Patients with OIED were taking a higher median 24-hour opioid dose than those without OIED (45 vs. 30 mg).

It was concluded that OIED is more prevalent in patients taking oxycodone or hydrocodone, compared with tramadol. There is a greater likelihood of OIED developing with higher doses. Reducing the opioid dose or changing to tramadol may reduce OIED in opioid users.

Snyder, D., Crowell, M., Horsley-Silva, J., et al. “Opioid-Induced Esophageal Dysfunction: Differential Effects f Type and Dose.” American Journal of Gastroenterology 2019; Vol. 114, pp. 1464-1469.

Murray H. Cohen, DO, “From the Literature” Editor, is on the Editorial Board of Practical Gastroenterology.