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United European Gastroenterol J. 2019 Feb;7(1):7-20. doi: 10.1177/2050640618818305. Epub 2018 Dec 14.

Pathophysiology and management of opioid-induced constipation: European expert consensus statement.

Author information

1
Institute of Applied Clinical Science, Keele University, Keele, UK.
2
Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
3
Centre for Trauma and Neuroscience, Queen Mary University of London, London, UK.
4
Division of Gastroenterology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
5
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, USA.
6
Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
7
Marymount University Hospital and Hospice, Curraheen, Ireland.
8
Cork University Hospital, Wilton, Ireland.
9
Leuven Centre for Algology and Pain Management, University of Leuven, Leuven, Belgium.
10
Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium.

Abstract

Background:

Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options.

Objective:

The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice.

Methods:

This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature.

Results:

The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed.

Conclusion:

Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.

KEYWORDS:

Opioid-induced constipation; bowel dysfunction; gastro-intestinal motility; gastroenterology; management algorithm

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