Wake Forest Baptist Health Winston-Salem, North Carolina
Troy Pleasant, MD1, Steven Clayton, MD2; 1Wake Forest Baptist Health, Winston-Salem, NC; 2Wake Forest University, School of Medicine, Winston-Salem, NC
Introduction: Esophagogastric junction outflow obstruction (EGJOO) is defined by the Chicago Classification of Esophageal disorders (CC) as an incomplete relaxation (elevated median IRP) along with an intact or weak peristalsis. There are a number of etiologies of EGJOO, from medication effects to mechanical processes. Preliminary studies have suggested that opioids may impair lower esophageal function. The aim of our study was to assess this in a patient population by comparing the frequency of chronic opioid use in patients diagnosed with EGJOO versus patients with normal manometries. Methods: 12 months of High-Resolution Manometry (HRM) results from a single academic center (Wake Forest Baptist Medical Center) were reviewed. Studies were designated as normal or EGJOO based on CCv3. Retrospectively, all patient’s home medications were examined, with a focus on prescription opioids. Patients who were prescribed daily opioids for greater than 6 months leading up to their HRM were labeled as chronic opioid users. The number of chronic opioid users in the normal result group were compared to the number of chronic opioid users in the EGJOO group. Results: After reviewing the HRM results, 121 patients had normal manometries and 121 patients were found to have HRM consistent with EGJOO. After reviewing patient’s medication lists, 9 of the normal manometry group were found to have chronic daily opioid use (7.44%), while 20 of the EGJOO group were found to have chronic opioid use (16.53%). Using a chi square analysis, it was found there was a statistically significant difference (p-value 0.0294, p < .05) in number of chronic opioid users found in the EGJOO group (16.53%) compared to the group with normal HRM findings (7.44%). Table 1 summarizes the demographics. Table 2 details the initial chief complaint of the patients. Discussion: In our study, chronic opioid use was found to be more prevalent in patients with the manometric diagnosis EGJOO than those with normal manometries. These results support chronic opioid use as a suspected etiology in EGJOO. As daily opioid use has become more common in recent decades, disorders of esophageal motility are one of the many adverse effects. This supports a trial off opioids in patients diagnosed with EGJOO with dysphagia to assess if symptoms resolve. Identifying opiates as a potential etiology, and improvement of symptoms after discontinuation of medications could potentially prevent other unnecessary procedures or therapies.
Table 1: Demographics
Table 2: Chief Complaints
Disclosures: Troy Pleasant indicated no relevant financial relationships. Steven Clayton indicated no relevant financial relationships.