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Erschienen in:
10.04.2023
Diagnosis and Management of Opioid-Induced Esophageal Dysfunction
Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 2/2023
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Purpose of Review
The purpose of this review is to discuss the pathophysiology, clinical presentation, and diagnosis of opioid-induced esophageal dysfunction (OIED) and describe the limited data available on its management.
Recent Findings
OIED is defined by chronic opioid use, esophageal symptoms, and specific manometric abnormalities. Larger retrospective studies show that patients with OIED present with significant esophageal symptoms particularly dysphagia. High-resolution esophageal manometry findings in OIED include distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, and hypercontractile esophagus. OIED is more prevalent in patients taking the stronger opioids oxycodone and hydrocodone compared to tramadol, and OIED is more frequent at higher 24-h morphine equivalent doses. Limited retrospective data suggest holding opioids may reverse manometric findings.
Summary
OIED is a clinico-manometric diagnosis which causes significant esophageal symptoms. Management of OIED is not well defined. Based on limited retrospective studies, complete opioid cessation or dose reduction is the current treatment recommendation. Future prospective studies are needed to guide management strategies.