Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
Dis Esophagus. 2018 Nov 1;31(11). doi: 10.1093/dote/doy053.
Opiates can cause heartburn and spastic esophageal dysmotility but their role in noncardiac chest pain (NCCP) is not known. Our aim was to characterize opiate effects on esophageal function using esophageal pH monitoring and high-resolution manometry (HREM) in these patients.We performed a cross sectional study of opiate users with NCCP who underwent HREM and esophageal pH study from 2010 to 2017 using opiate nonusers as a comparison group. Demographic data, symptoms, opiate use, endoscopic findings, esophageal pH study parameters, and HREM data were abstracted.Thirty three patients with NCCP on opiates were compared to 144 opiate non-users. Compared to opiate nonusers, opiate users had lower total acid exposure (2.3% vs. 3%, P = 0.012), lower upright acid exposure (1.2% vs. 3.1%, P = 0.032) and lower DeMeester score (6.5 vs. 12.7, P = 0.016). Opiate users also had higher lower esophageal sphincter integrated relaxation pressure (LES-IRP) (7.0 mm Hg [2.2, 11.7] vs. 3.7 mm Hg [1.1, 6.2] P = 0.011) and greater mean distal contractile integral (DCI) (2575 mm.Hg.s.cm [1134, 4466] vs. 1409 mm.Hg.s.cm [796, 3003] P = 0.03) than opiate non-users. The prevalence of hypertensive motility disorders (15.2% vs. 11.1%) and achalasia (12.1% vs. 2.1%) was higher in opiate users (P = 0.039) but did not reach significance on multivariate analysis.In patients presenting with NCCP, opiate users had lower esophageal acid exposure compared to opiate nonusers. This might be due to higher LES pressures preventing reflux and higher DCI leading to more rapid acid esophageal clearance.
阿片类药物可引起胃灼热和痉挛性食管运动障碍，但它们在非心源性胸痛（NCCP）中的作用尚不清楚。我们的目的是使用食管 pH 监测和高分辨率测压（HREM）来描述阿片类药物对这些患者食管功能的影响。
我们对 2010 年至 2017 年期间接受 HREM 和食管 pH 研究的 NCCP 阿片类药物使用者进行了一项横断面研究，并将阿片类药物非使用者作为对照组。提取人口统计学数据、症状、阿片类药物使用、内镜检查结果、食管 pH 研究参数和 HREM 数据。
将 33 名 NCCP 阿片类药物使用者与 144 名阿片类药物非使用者进行比较。与阿片类药物非使用者相比，阿片类药物使用者的总酸暴露量较低（2.3%比 3%，P=0.012），直立酸暴露量较低（1.2%比 3.1%，P=0.032），DeMeester 评分较低（6.5 比 12.7，P=0.016）。阿片类药物使用者的食管下括约肌整合松弛压力（LES-IRP）也较高（7.0mmHg[2.2，11.7]比 3.7mmHg[1.1，6.2]，P=0.011），平均远端收缩积分（DCI）较大（2575mmHg.s.cm[1134，4466]比 1409mmHg.s.cm[796，3003]，P=0.03）。阿片类药物使用者中高血压运动障碍（15.2%比 11.1%）和贲门失弛缓症（12.1%比 2.1%）的患病率较高（P=0.039），但多变量分析未达到显著水平。
在出现 NCCP 的患者中，阿片类药物使用者的食管酸暴露量低于阿片类药物非使用者。这可能是由于较高的食管下括约肌压力防止反流和较高的 DCI 导致更快的酸食管清除。
