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Pathophysiology and management of opioid-induced constipation: European expert consensus statement
- Source :
- United European Gastroenterology Journal; February 2019, Vol. 7 Issue: 1 p7-20, 14p
- Publication Year :
- 2019
-
Abstract
- 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. 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. This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature. 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. 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.
Details
- Language :
- English
- ISSN :
- 20506406 and 20506414
- Volume :
- 7
- Issue :
- 1
- Database :
- Supplemental Index
- Journal :
- United European Gastroenterology Journal
- Publication Type :
- Periodical
- Accession number :
- ejs55052475
- Full Text :
- https://doi.org/10.1177/2050640618818305