To date, few studies have assessed the effect of opioids on esophageal motility, mostly
assessed the effect of single-dose intravenous morphine on esophageal motility. Recently a
large retrospective study assessing the effect of opioids on esophageal motility found that
esophageal motor dysfunction are common in chronic opioid users whether studied on opioids
and off opioids. In addition, current opioid users also had significantly higher integrated
relaxation pressure and manometric patterns consistent with type III achalasia. (Ratuapli
2015) Peripherally acting mu opioid receptor antagonists (PAMORA) appear to be useful to
reduce the peripheral effects of mu opioid receptor agonists to delay gastrointestinal
transit without affecting the centrally mediated analgesic effects. MOVANTIK™ (Naloxegol) is
the first oral peripherally acting mu opioid receptor antagonists for opioid-induced
constipation. MOVANTIK™ (Naloxegol) has been recently approved for opioid-induced
constipation. Given orally, 25 mg daily it improves symptoms of constipation. At this dose,
MOVANTIK™ (Naloxegol) is effective and safe, with a limited side effect profile and is
associated with preservation of centrally mediated analgesia.
This study will explore the safety and tolerability of MOVANTIK™ (Naloxegol) in this patient
population.
The investigational hypothesis is that MOVANTIK™ (Naloxegol) could improve opioid- induced
esophageal motility disorders