INTRODUCTION: We aimed to conduct a systematic review and meta-analysis to assess the impact of chronic opioid exposure on esophageal motility in patients undergoing manometric evaluation. METHODS: Multiple databases were searched through October 2022 for original studies comparing the manometric results of patients who have used chronic opioids (for >90 days) with those who do not. The primary outcomes were esophageal dysmotility disorders. Three high-resolution manometry parameters were conducted as secondary outcomes. A random-effects model was applied to calculate the odds ratio (OR) and means difference (MD) along with a 95% confidence interval (CI). RESULTS: Nine studies were included in this meta-analysis. Opioid use was associated with higher esophageal dysmotility disorders, including distal esophageal spasm (pooled OR 4.84, 95% CI 1.60-14.63, P 5 0.005, I² 5 96%), esophagogastric junction outflow obstruction (pooled OR 5.13, 95% CI 2.11-12.43, P 5 0.0003, I²5 93%), and type III achalasia (pooledOR 4.15, 95% CI 2.15-8.03, P<0.0001, I²5 64%). No significant differences were observed for hypercontractile esophagus, type I achalasia, or type II achalasia. The basallower esophageal sphincter pressure (MD 3.02, 95% CI 1.55-4.50, P< 0.0001, I² 5 90%), integrated relaxation pressure (MD 2.51, 95% CI 1.56-3.46, P < 0.00001, I² 5 99%), and distal contractile integral (MD 640.29, 95% CI 469.56-811.03, P < 0.00001, I² 5 91%) significantly differed between the opioid use and nonopioid use group. However, opioid use was associated with a lower risk of ineffective esophageal motility (pooled OR 0.68, 95% CI 0.49-0.95, P 5 0.02, I² 5 53%). DISCUSSION: Chronic opioid exposure is associated with an increased frequency esophageal dysmotility disorders. Our results revealed that opioid use is significantly associated with type III achalasia but not with type I and II achalasia. Therefore, opioid treatment should be taken into account as a potential underlying risk factor when diagnosing these major esophageal motor abnormalities. [ABSTRACT FROM AUTHOR]