Opioid-Induced Gastrointestinal Dysfunction

Mehendale, Sangeeta R.; Yuan, Chun‐Su

doi:10.1159/000090314

Cited by 66 publications

(43 citation statements)

References 109 publications

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“…A particular problem poses opioid induced constipation since QoL can be reduced due to pain, the underlying disease, as well as the side effects of opioids, particularly constipation [23] [24]. Though with long-term use many side effects associated with opioid therapy subside because of tolerance, constipation does apparently not and can significantly affect QoL [23].…”

Section: Discussionmentioning

confidence: 99%

Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

Müller-Lissner¹,

Richter²,

Eberlin³

et al. 2017

OJGas

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Background: Quality of life (QoL) is impaired in chronic constipation. Among nonprescription laxatives QoL data out of randomized controlled trials are available only for bisacodyl and sodium picosulfate (SPS). Methods: In two randomized, double-blind, placebo-controlled, parallel-group trials, the efficacy and safety of treatment with either bisacodyl or SPS, respectively, were assessed. After a 2-week baseline period patients with functional constipation were randomized to a 4-week treatment with either bisacodyl (2 tablets = 10 mg), SPS (18 drops = 10 mg), or matching placebo in a ratio of active drug to placebo of 2:1. Dose reduction as well as resuming the original dose was permitted. Patients who did not experience a bowel movement for more than 72 h were allowed to use a bisacodyl suppository. The primary endpoint was the mean number of Complete Spontaneous Bowel Movements (CSBMs) per week during the trial. QoL was assessed using the Patient Assessment of Constipation (PAC)-QoL questionnaire. Results: Active treatment led to a greater improvement of PAC-QoL scores for every domain. Active treatment was also superior to placebo for all individual questions of the questionnaire. Of note, SPS or bisacodyl not only improved satisfaction with stool patterns ("quite a bit/extremely satisfied" in 12.8% of patients on placebo and 50.3% on active treatment) but bloating was also considerably ameliorated ("not at all feeling bloated" in 24.5% on placebo and 41.4% on active treatment). Conclusion: Bisacodyl and SPS not only improve stool variables but also quality of life in patients with chronic functional constipation.

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Section: Discussionmentioning

confidence: 99%

Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

Müller-Lissner¹,

Richter²,

Eberlin³

et al. 2017

OJGas

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“…When opiates bind to the opiate receptors in the GI tract, they interfere with peristalsis and the mucous secretion required for bowel movements [11][12][13][14][15]. Use of exogenous opioids reduces peristalsis.…”

Section: Introductionmentioning

confidence: 99%

Methylnaltrexone or laxatives for the Management of Opioid-induced Constipation among Palliative Patients on Opioid Therapy: Evidencebased Review

Ass¹

2016

Adv Practice Nurs

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“…Les cellules neuronales et endocrines du tractus digestif sont le lieu de production d'opioïdes endogènes qui ont pour effet d'inhiber l'activité nerveuse intestinale et, en consé-quence, les mécanismes de propulsion et de sécrétion intestinale [8,17]. Parmi les trois récepteurs aux opiacés (mu, delta et kappa), le récepteur mu est le principal médiateur de l'action des agonistes opioïdes sur le système digestif [9].…”

Section: Introductionunclassified

Opioids antagonists and constipation

Béziaud

Pellat²,

Granger

et al. 2010

Douleur analg

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La constipation est quasi systématique lors d'un traitement opioïde, elle est en partie liée à l'activation des récepteurs opioïdes périphériques du tractus digestif. Chez le patient douloureux, la constipation s'ajoute à ses souffrances et limite la gestion efficace des douleurs, l'incitant à la nonobservance. La naloxone à libération prolongée et la méthyl-naltrexone sont efficaces respectivement pour limiter et traiter cette constipation induite par les opioïdes (CIO). De récentes études confirment leur efficacité sans affecter l'analgésie. Ainsi, avec une meilleure connaissance de la prévalence et de la physiopathologie de la CIO, une nouvelle approche pour prévenir et traiter la constipation est possible. Elle devrait permettre d'améliorer la qualité de vie des patients douloureux.Abstract Constipation is a common adverse effect associated with opioid therapy; it is mediated primarily by stimulation of opioid receptor in the gastrointestinal tract. In patients with pain, uncontrolled constipation can add to their discomfort and may serve as a barrier to effective pain management, limiting therapy, or prompting discontinuation. Prolonged-release of naloxone and methylnaltrexone are effective, respectively, for preventing and treating the symptoms of constipation in patients treated with opioids. Early studies confirm that they are effective without entering the central nervous system and affecting analgesia. With a better understanding of the prevalence and pathophysiology of opioid-induced constipation, a new approach to reducing and treating constipation is also possible and will likely improve the quality of life of patients with pain.

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Opioid-Induced Gastrointestinal Dysfunction

Cited by 66 publications

References 109 publications

Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

Bisacodyl and Sodium Picosulfate Improve Bowel Function and Quality of Life in Patients with Chronic Constipation—Analysis of Pooled Data from Two Randomized Controlled Trials

Methylnaltrexone or laxatives for the Management of Opioid-induced Constipation among Palliative Patients on Opioid Therapy: Evidencebased Review

Opioids antagonists and constipation

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