Pathophysiology, diagnosis, and management of opioid-induced constipation

Farmer, Adam D.; Holt, Caroline Bruckner; Downes, Thomas J; Ruggeri, Eugenio; Vecchio, Sara Del; Giorgio, Roberto De

doi:10.1016/s2468-1253(18)30008-6

Cited by 100 publications

(92 citation statements)

References 67 publications

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“…Constipation is a common side effect of opioid use that can affect up to 81% of patients, even with the concomitant use of laxatives . Due to the increasing use of opioids in Western countries, there is a strong need to rule out the use of opioids in patients with constipation, especially considering that opioid consumption is not always reported by patients …”

Section: Resultsmentioning

confidence: 99%

European society of neurogastroenterology and motility guidelines on functional constipation in adults

Serra

Pohl

Azpiroz

et al. 2019

Neurogastroenterology Motil

161

151

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Introduction: Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation.Design: After a thorough review of the literature by experts in relevant fields, including gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal motility testing from various European countries, a Delphi consensus process was used to produce statements and practical algorithms for the management of chronic constipation. 2 of 33 | SERRA Et Al. | INTRODUC TI ONChronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. 1,2 Its prevalence increases with age 3,4 and consequently is expected to rise over the next few years, 5 in parallel with the predicted increase in longevity of the European population. Constipation is a symptom that may have diverse etiologies, and for this reason, several diagnostic approaches and treatment options are available, ranging from simple lifestyle changes and general measures to sophisticated pharmacological treatments and surgical interventions. 6 In an attempt to unify the health care received by the population across Europe, the European Society of Neurogastroenterology and Motility (ESNM) decided to develop European guidelines to help physicians to take the best decisions to improve the quality of health in patients suffering from common functional and motor disorders. In this document, we present the ESNM guidelines for chronic constipation, which are intended to be a useful tool for the management of this condition in the general population in Europe. In order to produce comprehensive guidelines addressing the different aspects related with constipation, experts from European countries working in related fields developed relevant statements after a thorough review of the available literature, and final recommendations and management algorithms were produced following a Delphi consensus process. | ME THODS | ParticipantsA chair (Jordi Serra) and co-chair (Daniel Pohl) were commissioned by the ESNM Steering Committee to develop the guidelines. A panel of 12 experts from different European countries, constituted by gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal (GI) motility testing, was invited by the chairs to participate in the development of the guidelines. Each expert was assigned to develop a specific area of the document (see below) and to establish a team with one or two co-workers to complete the assigned task. The final ESNM guidelines working group was composed of 13 experts and 9 co-authors. | The Delphi consensusEach expert and co-worker conducted a thorough review of the literature in their specific field of expertise. The following areas were covered by the different subgrou...

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Section: Resultsmentioning

confidence: 99%

European society of neurogastroenterology and motility guidelines on functional constipation in adults

Serra

Pohl

Azpiroz

et al. 2019

Neurogastroenterology Motil

161

151

View full text Add to dashboard Cite

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“…Differences at slow and very fast velocities indicated by asterisks (*) The pathophysiological mechanisms underlying OIC is complex, and colonic dysmotility is believed to have an essential contribution. 3 This makes colonic motility especially important when describing the GI side effects of opioids. It is well known that opioids cause prolonged colonic transit time.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory assessment of colonic motility using the electromagnetic capsule tracking system: Effect of opioids

Mark

Klinge

Grønlund

et al. 2019

Neurogastroenterology Motil

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Background Opioid treatment often causes debilitating constipation. However, it is not well described how opioids affect colonic motility and whether opioid‐induced constipation is due to either a decrease of powerful peristaltic contractions or “uncoordinated” peristalsis. The present study aims to investigate the effect of oxycodone on parameters of colonic motility and to determine whether motility is normalized by the opioid antagonist naloxegol. Methods In two randomized, double‐blind crossover trials, oxycodone or placebo was administered to 25 healthy males (Trial A), while another 24 healthy males were administered oxycodone with naloxegol or placebo (Trial B). Colonic motility was assessed by tracking the progression of an electromagnetic capsule throughout the large intestine. Segmental colonic transit times and capsule movements were calculated using displacement distance and velocity. Key Results In Trial A, colonic transit time increased during oxycodone treatment compared with placebo (39 vs 18 hours, P < .01). Displacement during long fast antegrade movements was shorter during oxycodone treatment than with placebo (10 vs 20 cm, P = .03). In Trial B, colonic transit time was faster during oxycodone + naloxegol than during oxycodone + placebo (40 vs 55 hours, P = .049), mainly caused by an increase of the percentwise fraction of distance covered by fast movements in the left colon (P = .001). Conclusion & Inferences Oxycodone treatment impaired colonic motility, manifested as increased transit time, specifically decreased long fast antegrade movements, and addition of naloxegol improved motility dynamics. In humans, the increased transit time during opioid treatment is caused by a decrease in long fast movements rather than uncoordinated peristalsis.

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“… 3 This binding leads to reduced bowel tone, slowed peristaltic activity, and decreased mucosal secretions, which can delay gastric emptying, slow intestinal transit, and increase fluid absorption in the gastrointestinal tract. 17 These opioid-induced gastrointestinal effects can lead to difficulties in evacuating feces, excessive straining, hard stools, abdominal discomfort, and bloating. 9 , 18 – 20 Difficulty in rectal evacuation may also be related to increased anal sphincter tone and decreased reflex relaxation.…”

Section: Overview Of Oicmentioning

confidence: 99%

Opioid-induced Constipation

Argoff¹

2020

The Clinical Journal of Pain

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Objective: The objective of this study was to provide an overview of opioid-induced constipation (OIC) and its influence on disease burden and quality of life (QOL). Methods: This is a narrative review. Results: For many patients, opioid-related side effects, the most common being OIC, have the potential to significantly impair patients’ QOL. Patients with OIC often experience substantial overall burden (ie, increases in anxiety and depression, impairments in activities of daily living, low self-esteem, feelings of embarrassment) and economic burden (ie, higher health care costs, more frequent doctor visits, increased out-of-pocket medication costs), which often causes patients to modify or discontinue opioid treatment despite the analgesic benefits. OIC occurs when opioids bind to peripheral μ-opioid receptors in the gastrointestinal tract. Currently, 4 Food and Drug Administration (FDA)-approved medications are available for OIC, 3 of which are peripherally acting µ-opioid receptor antagonists (PAMORAs). PAMORAs block µ-opioid receptors in the gastrointestinal tract without affecting the central analgesic effects of the opioid and thus provide a targeted approach to OIC management. Two PAMORAs, naldemedine and methylnaltrexone, have shown significant improvements in QOL based on the Patient Assessment of Constipation Symptoms questionnaire relative to placebo. Along with pharmacologic management for OIC, health care providers should institute comprehensive communication strategies with patients to ensure OIC is effectively recognized and managed. Discussion: OIC has both physical and psychological impacts on patients. PAMORAs provide effective relief of OIC while also improving QOL. To augment the pharmacologic management of OIC, proactive counseling approaches between physicians and patients may help relieve some of the patient burden associated with OIC and lead to improved outcomes.

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Pathophysiology, diagnosis, and management of opioid-induced constipation

Cited by 100 publications

References 67 publications

European society of neurogastroenterology and motility guidelines on functional constipation in adults

European society of neurogastroenterology and motility guidelines on functional constipation in adults

Ambulatory assessment of colonic motility using the electromagnetic capsule tracking system: Effect of opioids

Opioid-induced Constipation

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