World Congress at ACG2017

Simultaneous Plenary Session 4B: Esophagus / Colon

70 - Effect of Opiates on Esophageal Function Testing in Patients With Non-cardiac Chest Pain

Wednesday, October 18
9:40 AM - 9:50 AM
Location: Valencia Ballroom D (Level 4)



Category: Esophagus       

Juan D. Gomez Cifuentes, MD
Cleveland Clinic Foundation, Cleveland, OH
Introduction:
Recent studies have reported that opiates can cause spastic esophageal dysmotility but their contribution to noncardiac chest pain (NCCP) is not clearly known. Our aim was to characterize opiate effects on esophageal function using high resolution manometry (HREM) and esophageal pH monitoring in patients presenting with NCCP.

Methods: We performed a retrospective study of patients who underwent HREM and esophageal pH study for evaluation of NCCP at our institution from January 2010 to January 2017. Demographic data, clinical presentation, opiate use, endoscopic findings, esophageal pH study parameters and HREM data were included. HREM studies were interpreted based on Chicago classification version 3.0. Patients with active opiate use at the time of testing were compared to those who were not on opiates. Data is presented as mean ± standard deviation, median [25th, 75th percentiles] or frequency (percent).

Results:
Among a total of 177 patients, 33 (18.6%) patients had an active opiate prescription at the time of HREM and 144 (81.3%) were identified as non-opiate users. Opiate users were more likely to complain of dysphagia and to have a concomitant antidepressant prescription (table 1). No statistical significance difference was found between 2 groups based on age, gender, race, smoking status, alcohol use and prevalence of abnormal endoscopic findings.

On HREM, active opiate users had higher lower esophageal sphincter (LES) integrated relaxation pressure (IRP) (p=0.011), greater average distal contractile integral (DCI) (p=0.03) and shorter distal latency (p=0.018) than opiate non users (table 2). The prevalence of hypertensive peristalsis (15.2% vs 11.1%) and achalasia (12.1% vs 2.1%) was also higher in opiate users (p=0.039).

Interestingly, patients on opiates were more likely to have a normal esophageal acid exposure compared to non-users (table 2). In opiate users, total time pH < 4 was 2.3 % [0.2, 5.1] vs 3% [0.65, 9.1], upright time pH < 4 was 1.2% [0.2, 5.4] vs 3.1% [0.9, 8.1] and supine time pH < 4 was 0.6%[0, 5.4] vs 0.6%[0, 5.8].

Discussion:
Among patients presenting with NCCP, opiate users more likely to have dysphagia and spastic esophageal motility disorders. However, they had normal esophageal acid exposure compared to non-opiate users. This might be due to higher LES–IRP preventing reflux and higher DCI leading to more rapid acid esophageal clearance in opiate users.

Supported by Industry Grant: No


Patient Characteristics by Use of Opiates





































































Factor

No opiates
(N=144)


Opiate users
(N=33)

p-value


Age (years) 54.0±13.3 55.2±10.9 0.62a

Female gender


95(66.0) 24(72.7) 0.46b
Caucasian race

128(91.4)



27(81.8)


0.10b
Non-smoker 85(59.0) 17(51.5) 0.18b
Alcohol: Never users 60(41.7) 17(51.5)

0.071b


Heartburn 71(49.3) 15(45.5) 0.69b
Regurgitation 54(37.5) 11(33.3)

0.65b


Dysphagia 42(29.2) 16(48.5) 0.033b
Abnormal endoscopy findings

55(38.2)



17(51.5)



0.16b


Acid supressive medication 102(70.8) 28(84.8)

0.10b



Statistics presented as Mean ± SD, Median [P25, P75] or N (column %).


p-values: a=ANOVA, b=Pearson's chi-square test.


Esophageal function testing


















































































































Factor No opiates
(N=144)
Opiate users
(N=33)

p-value


HREM Findings:
Basal LES pressure (mm)

23.0[12.9,33.5]


24.8[15.4,36.4] 0.54b
LES-IRP (mm) 3.7[1.1,6.2]

7.0[2.2,11.7]



0.011b



Contractile front Velocity (cm/s)



3.4[2.7,4.3]



3.5[3.1,4.9]


0.20b
Mean DCI (mm.Hg.s.cm) 1409 [796,3003]

2575 [1134,4466]


0.030b
Distal Latency (sec) 6.7[6.0,7.7] 6.0[5.2,6.8] 0.018b
Normal

101(70.1)


21(63.6) 0.039a
Hypotensive peristalsis

101(70.1)


21(63.6)
Hypertensive peristalsis 24(16.7) 3(9.1)
Achalasia or EGJ Outflow Obstruction

16(11.1)


5(15.2)
Esophageal pH Monitoring:
Total pH time <4 ≥5.5% 56(38.9) 6(18.2)

0.025a


Upright pH time <4 ≥8.2% 35(24.3) 5(15.2) 0.26 a
Supine pH time <4 ≥3% 48(33.3) 9(27.3) 0.5 a
Postprandial pH time <4 ≥6.8% 29(28.2) 6(22.2) 0.54 a
DeMeester Score 12.7[3.4,28.8] 6.5[0.30,18.0] 0.016b
Symptom Index for Chest pain > 50% 12(8.3) 2(6.1) 0.66a
Symptom sensitivity index for chest pain > 10% 3(2.6) 3(10.0) 0.068a
Symptom association probability for chest pain > 95% 6(5.2) 3(10.0) 0.33a

Statistics presented as Mean ± SD, Median [P25, P75] or N (column %).
P-values: a=Pearson's chi-square test, b=Kruskal-Wallis test.


Citation: . EFFECT OF OPIATES ON ESOPHAGEAL FUNCTION TESTING IN PATIENTS WITH NON-CARDIAC CHEST PAIN. Program No. 70. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Juan D. Gomez Cifuentes

Resident
Cleveland Clinic Foundation
Cleveland, Ohio

Presentation(s):

Send Email for Juan Gomez Cifuentes


Assets

70 - Effect of Opiates on Esophageal Function Testing in Patients With Non-cardiac Chest Pain



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Effect of Opiates on Esophageal Function Testing in Patients With Non-cardiac Chest Pain