Achalasia Type 3 Is More Commonly Found With Opioid Use Compared to Esophagogastric Junction Outflow Obstruction: A Single Center Experience of 75 Patients

Abstract

Introduction: Opioid misuse is a US health crisis with inadvertent prescription use and unwarranted diagnostic testing stemming from adverse effects. Opioids are shown to be associated with esophageal dysmotility including esophagogastric junction outflow obstruction (EGJOO) and achalasia type III. However, it is not clear what HRM pattern is more frequent manifestation of opioid use. We retrospectively analyzed esophageal high resolution manometry (HRM) studies from year 2013-2016 from a single academic center for effect of opioid use on patterns of esophageal dysmotility to determine whether EGJOO vs achalasia type III diagnosis was more common manifestation. Methods: HRM records (years 2013-2016) from university hospital were analyzed and studies with diagnosis of EGJOO and achalasia type III were extracted. Following variables were gathered: indication, gender, constipation, distal latency period (DLP: >4.5 sec or<4.5 sec), opioid use 1 month, 2 weeks and 1 week before procedure and day of procedure and final HRM diagnosis. Opioid use was evaluated for likelihood of pattern of HRM diagnosis (achalasia type III vs EGJOO) using Chi-square and logistic regression analysis. Measure of effect was odds ratio(OR) with 95% confidence interval(CI) and P-value<0.05 was considered for statistical significance. Statistical software Stata v14 (Statacorp, 2015) was used for analysis. Results: Of 75 patients, 61 were females and primary indication was dysphagia (n=53) followed by GERD (n=12). Achalasia type III was likely to be diagnosed when opioids were used in last 1 week compared to EGJOO with an OR of 7.82 (95%CI 2.24-28.3, P<0.01). Opioid use in last 1 week was significantly associated with DLP<4.5 with OR of 7.7 (95% CI 2.44-24.01, P<0.01). Dysphagia was most common indication for HRM with opioid use compared to GERD or other symptoms (OR 2.15, 95%CI 0.39-21.9, P=0.49). On logistic regression, EGJOO (OR 0.17, p 0.02) and DLP >4.5 sec (OR 0.13, P<0.01) were less likely with opioid use in last one week while gender, smoking and constipation did not have any significant association. Reciprocal results were found for opioid use in last 1 month, last 2 weeks and on day of HRM. Limitations: single center data and retrospective analysis in lack of control arm. Conclusion: Achalasia type III was much commonly found compared to EGJOO if opioids were used in last one week of esophageal manometry testing.