Introduction: Effect of Opioid on Gastrointestinal motility are well documented and increasing attention is being paid to their effect on esophageal motility. Spastic Disorders like Achalasia type lll, Esophageal Gastric Outlet Obstruction, and Distal Esophageal Spasm are reported with the use of opioids. Decreased incidence has been reported after withholding opioids. Naloxegol is a peripherally acting mu opioid receptor antagonist approved for opioid induced constipation, however it's effect on Opioid induced esophageal dysmotility are not known.
Methods: We studied 2 patients with opioid induced constipation and concurrent esophageal motility disorders with esophageal High Resolution Manometry while on Opioids and studies were repeated after placing them on Naloxegol 25 mg daily for 5 days. Studies were interpreted based on Chicago Classification 3.0. Esophageal motility disorder subtype, Distal Contractile Integral (DCI), Integrated Relaxation Pressure(IRP), and Distal Latency(DL) were recorded for each of the 10 water swallows and compared with paired t test. Case -1. 67 year old male on Oxycodone 30 mg twice daily with Dysphagia. Manometry showed Jackhammer esophagus which converted to normal study with Naloxegol 25 mg po daily with resolution of symptoms. DCI decreased from 10092 mmHgcm to 2559 mmHgcm, ( P< 0.05) Case 2. 73 year old female on Oxycodone 10 mg q 6 hours with Dysphagia and regurgitation. Manometry showed Achalasia type lll which converted to Type ll Achalsia with Naloxegol with significant decrease in regurgitation and mild improvement in dysphagia. DCI decreased from 5900 mmHgcm to 2887 mmHgcm.
In both patients there was a significant decrease in DCI after initiating Naloxegol (p< 0.05). Discussion: Naloxegol could successfully decrease DCI in our 2 patient with opioid induced esophageal disorders and change esophageal manometric signatures favorably with improvement in clinical symptoms. Larger studies are needed with different opioids to study and confirm dose- effect relationships.
Effect Of Naloxegol on Opiod induced disorder
Disclosures: Tarun Sharma indicated no relevant financial relationships. Kristin Ciezki indicated no relevant financial relationships. Megan Jacobson indicated no relevant financial relationships. Maharaj Singh indicated no relevant financial relationships. Crista Ulteig indicated no relevant financial relationships.