Northwestern University Feinberg School of Medicine Chicago, IL
Erica N. Donnan, MD, Alexandra J. Baumann, DO, Tiffany Taft, PsyD, John E. Pandolfino, MD, MSCI, FACG, Dustin A. Carlson, MD, MSCI; Northwestern University Feinberg School of Medicine, Chicago, IL
Introduction: Opioids affect the ability of the lower esophageal sphincter muscle to relax after a swallow and spastic contractions are more likely in patients on chronic opioids. Opioids may create abnormalities that mimic achalasia. We hypothesize that patients on chronic opioids will experience more dysphagia symptoms than patients not on opioids. The objective of this study was to assess for dysphagia in opioid users compared to non-opioid users. Methods: Adult subjects (aged 18-85 years) were recruited via the online research website ResearchMatch.org. Individuals that consented completed an online survey that included demographic and clinical information, and opioid use including dose, frequency, indication and length of time prescribed. The survey also included the Brief Esophageal Dysphagia Questionnaire (BEDQ), a validated self-report measure assessing the frequency and severity of dysphagia. The BEDQ yields scores ranging from 0 (asymptomatic) – 40, with greater scores indicating greater dysphagia severity; a threshold ≥10 indicates severe dysphagia. Results: 436 participants completed the survey; 185 (42%) of these subjects were on opioids. Subjects on opioids were older, had greater BMI, were more likely to be on a proton pump inhibitor, have a previous GI clinic visit, have a previous upper endoscopy, and have previous foregut surgery (Table 1). Only 1 subject (< 1%) was taking opioids for esophageal symptoms. Subjects on opioids had higher BEDQ scores, median (IQR) 3 (0-9) vs 0 (0-3), P< 0.001, and more frequently had BEDQ≥10, 38/146 (21%) vs 27/224(11%), P=0.006, than subjects not on opioids. Among opioid users, morphine equivalent of opioid use did not significantly correlate with BEDQ score (rho = 0.068; P=0.371). Among opioid users, BEDQ scores were similar based on duration (P=0.908) and frequency (P=0.364) of opioid use (Table 2). Discussion: In a study utilizing an online survey completed by 436 subjects of which 185 were on opioids, participants on opioids more frequently had clinical GI evaluations and had more severe dysphagia than those not on opioids. As opioids are associated with esophageal motor dysfunction, the impact and importance of opioid use should be considered among patients being treated with opioids and also patients on opioids seeking GI care. As a dose effect of opioids was not detected, additional research into factors related to opioid-associated dysphagia and motor dysfunction are warranted.
Table 1. Demographic and clinical characteristics of study sample by opioid use.
Table 2. Dysphagia score based on opioid use. Values among subjects on opioids.
Disclosures: Erica Donnan indicated no relevant financial relationships. Alexandra Baumann indicated no relevant financial relationships. Tiffany Taft: Abbvie – Speaker's Bureau. Janssen – Speaker's Bureau. John Pandolfino: Crospon – Patent Holder, Stockholder/Ownership Interest (excluding diversified mutual funds). Medtronic – Consultant, Speaker's Bureau. Dustin Carlson indicated no relevant financial relationships.