Opioid-Induced Esophageal Dysfunction: Differential Effects of Type and Dose

Am J Gastroenterol. 2019 Sep;114(9):1464-1469. doi: 10.14309/ajg.0000000000000369.


Objective: Data regarding opioid effects on esophageal function are limited. We previously demonstrated an association between chronic opioid use and esophageal motor dysfunction characterized by esophagogastric junction outflow obstruction, distal esophageal spasm, achalasia type III, and possibly Jackhammer esophagus. Our aim was to characterize the influence of different opioids and doses on esophageal dysfunction.

Methods: Retrospective review of 225 patients prescribed oxycodone, hydrocodone, or tramadol for >3 months, who completed high-resolution manometry from 2012 to 2017. Demographic and manometric data were extracted from a prospectively maintained motility database. Frequency of opioid-induced esophageal dysfunction (OIED, defined as distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, or Jackhammer esophagus on high-resolution manometry, was compared among different opioids. The total 24-hour opioid doses for oxycodone, hydrocodone, and tramadol were converted to a morphine equivalent for dose effect analysis.

Results: OIED was present in 24% (55 of 225) of opioid users. OIED was significantly more prevalent with oxycodone or hydrocodone use compared with tramadol (31% vs 28% vs 12%, P = 0.0162), and for oxycodone alone vs oxycodone with acetaminophen (43% vs 21%, P = 0.0482). There was no difference in OIED for patients taking hydrocodone alone vs hydrocodone with acetaminophen. Patients with OIED were taking a higher median 24-hour opioid dose than those without OIED (45 vs 30 mg, P = 0.058).

Discussion: OIED is more prevalent in patients taking oxycodone or hydrocodone compared with tramadol. There is greater likelihood of OIED developing with higher doses. Reducing the opioid dose or changing to tramadol may reduce OIED in opioid users.

MeSH terms

  • Abdominal Pain / drug therapy
  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Arthralgia / drug therapy
  • Back Pain / drug therapy
  • Dose-Response Relationship, Drug
  • Esophageal Achalasia / chemically induced*
  • Esophageal Achalasia / physiopathology
  • Esophageal Diseases / chemically induced
  • Esophageal Diseases / physiopathology
  • Esophageal Spasm, Diffuse / chemically induced*
  • Esophageal Spasm, Diffuse / physiopathology
  • Esophagogastric Junction / physiopathology
  • Female
  • Humans
  • Hydrocodone / administration & dosage
  • Hydrocodone / adverse effects
  • Male
  • Manometry
  • Middle Aged
  • Oxycodone / administration & dosage
  • Oxycodone / adverse effects
  • Retrospective Studies
  • Tramadol / administration & dosage
  • Tramadol / adverse effects


  • Analgesics, Opioid
  • Tramadol
  • Hydrocodone
  • Oxycodone