How do you diagnose and manage suspected opioid-induced esophageal dysfunction?

Patients with opioid-induced esophageal dysfunction have symptoms of most often, chest pain or dysphagia, with manometric findings of EGJ outflow obstruction, type 3 achalasia, or esophageal spasm/hypercontractile/jackhammer esophagus. When manometry suggests EGJOO or type 3 achalasia, in our practice, we do ensure that we get either a timed barium swallow or EndoFlip to further evaluate the EGJ/LES. In an ideal world, patients would either taper off their opioid or taper down the dose, but this is not always realistic. In patients whose motility abnormality does not resolve after cessation or dose reduction, or if either is not feasible, then in our practice, we generally treat in the same manner as other patients with EGJOO, type 3 achala...

HRM or Flip to diagnose EGOO then review need for opioids and alternatives.