J Neurogastroenterol Motil 2019; 25(2): 205-211  
Opioid Treatment and Excessive Alcohol Consumption Are Associated With Esophagogastric Junction Disorders
Valeria Schindler,1 Daniel Runggaldier,1,2 Amanda Bianca,1 Anton S Becker,3 Fritz Murray,1 Edoardo Savarino,4 and Daniel Pohl1*
1Division of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland; 2Department of Otorhinolaryngology, University Hospital of Zurich, Switzerland; 3Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland; and 4Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
Correspondence to: *Daniel Pohl, MD
Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistr. 100, 8091 Zurich, Switzerland, Tel: +41 44 255 11 11, Fax: +41 44 255 45 91, E-mail: daniel.pohl@usz.ch
Valeria Schindler and Daniel Runggaldier contributed equally to this work.
Received: September 6, 2018; Revised: December 6, 2018; Accepted: January 8, 2019; Published online: April 30, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: The influence of external factors such as opioids and alcohol has been extensively investigated for various segments of the gastrointestinal tract. However, the association between their use and the development of esophagogastric junction outflow obstruction disorders (EGJOODs) is unknown. Therefore, the aim of this study is to analyze prevalence and clinical relevance of opioids and alcohol intake in patients with EGJOODs.
Methods: In this single-center, retrospective study, we reviewed clinical and pharmacological data of 375 consecutive patients who had undergone high resolution impedance manometry for EGJOODs. EGJOODs were classified according to the Chicago classification version 3.0 and to recently published normal values for test meals. Demographics, manometric data, and symptoms were compared between different groups using Pearson’s chi-squared test, Fisher’s exact test, and multivariate analysis. A P < 0.05 was considered significant.
Results: EGJOOD was found in 30.7% (115/375) of all analyzed patients. The prevalence of opioids (14.8% vs 4.2%, P = 0.026) was significantly higher in patients with EGJOODs compared to patients without EGJOODs. Additionally, excessive alcohol consumption (12.2% vs 3.5%, P = 0.011) was associated with EGJOODs. Excessive alcohol consumption was especially frequent in the non-achalasia esophagogastric junction outflow obstruction subgroup (16.2%) and opioid use in the achalasia type III subgroup (20.0%).
Conclusions : We found a significant association between EGJOODs and opioid as well as excessive alcohol consumption. This underlines the importance of detailed history taking regarding medication and ethanol consumption in patients with dysphagia. Further prospective studies on mechanisms undelaying esophagogastric junction dysfunction due to opioids or alcohol are warranted.
Keywords: Alcohol drinking; Analgesics, Opioids; Esophageal achalasia; Esophagogastric junction; Manometry

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