*EMBARGOED All research presented at the 2019 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Monday, October 28, 2019, at 8:00 am CDT.
P0288 Opioids Interfere With Deglutitive Inhibition Assessed by Response to Multiple Rapid Swallows During High
Author Insight from Diana L. Snyder, MD, Mayo Clinic
What’s new here and important for clinicians?
We previously demonstrated an association between chronic opioid use and esophageal motor dysfunction characterized by esophagogastric junction outflow obstruction (EGJOO), achalasia type III, diffuse esophageal spasm (DES), and Jackhammer esophagus (JE) defined as opioid induced esophageal dysfunction (OIED). This is the first study describing the impact of opioids on deglutitive inhibition assessed during multiple rapid swallows. Furthermore, it provides direct evidence of impaired inhibitory signaling in the esophagus as a mechanism of action for patients with OIED. This is important for clinicians who send their patients for high resolution esophageal manometry since these medications may affect the outcome of this testing. An ideal goal would be for all patients to be weaned off opioids in order to reduce these adverse effects, but this is not always possible. We suggest that for patients who will remain on opioids long term, esophageal manometry should be performed while on these medications for an accurate esophageal motility assessment. For those patients on a short course of opioids, testing should be deferred until they are off these medications, or they should stop opioids at least 24 hours before manometry.
What do patients need to know?
Patients should be educated on the many side effects that opioid medications have on the gastrointestinal tract. Constipation is one of the most common adverse effects of opioids in the GI tract, but patients should also be aware of how these medications may affect their esophagus. Patients may experience difficulty with swallowing or chest pain while taking these medications. Educating our patients on how opioids can alter the motility of their esophagus is important.
Diana L. Snyder, MD, Mayo Clinic
snyder.diana [at] mayo [dot] edu
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