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

Authors :
Tony O'Brien
Giuseppe Chiarioni
Bart Morlion
Roberto De Giorgio
Jan Tack
Asbjørn Mohr Drewes
Adam D. Farmer
Source :
Farmer, A D, Drewes, A, Chiarioni, G, De Giorgio, R, O’Brien, T, Morlion, B & Tack, J 2019, ' Pathophysiology and management of opioid-induced constipation : European expert consensus statement ', United European Gastroenterology Journal, vol. 7, no. 1, pp. 7-20 . https://doi.org/10.1177/2050640618818305
Publication Year :
2019
Publisher :
Wiley, 2019.

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. ispartof: United European Gastroenterology Journal vol:7 issue:1 pages:7-20 ispartof: location:England status: published

Details

ISSN :
20506414 and 20506406
Volume :
7
Database :
OpenAIRE
Journal :
United European Gastroenterology Journal
Accession number :
edsair.doi.dedup.....a056e3922d4c2bc7e566ee56cf623d54
Full Text :
https://doi.org/10.1177/2050640618818305