Year 2024 / Volume 116 / Number 10
Review
Review document of the Spanish Association of Neurogastroenterology and Motility on the management of opioid-induced constipation

546-553

DOI: 10.17235/reed.2024.10242/2024

Jordi Serra, Javier Alcedo, Claudia Barber, Constanza Ciriza de los Ríos,

Abstract
Opioid-induced constipation (OIC) is a rising problem due to the progressive increase in opioid prescription. In contrast to functional constipation, opioid-induced constipation is not a functional gut disorder but a side effect of opioid use. Opioids produce constipation due to a decrease in gastrointestinal motility and a reduction in gastrointestinal secretions. The treatment of OIC focuses on three basic pillars: optimizing opioid drug indication, preventing constipation onset, and treating constipation should it develop. As with any other cause of constipation, lifestyle adjustments and laxatives should be the first-line option in the pharmacological management of OIC. Osmotic laxatives such as polyethylene glycol (PEG) are the agents of choice. PEG is inert and is neither fermented nor absorbed in the gastrointestinal tract. Furthermore, it has broad clinical applicability due to its favourable safety profile. If first-line treatments fail, peripheral μ-opioid receptor antagonists (PAMORA) are the drugs of choice. They reduce the peripheral effects of OIC with a minimal potential to diminish analgesia or induce a centrally mediated withdrawal syndrome. Different PAMORA are available in the market both for oral and subcutaneous administration, with demonstrated efficacy for the management of OIC in different clinical trials.
Share Button
New comment
Comments
No comments for this article
References
1. Bharucha AE, Lacy BE. Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology 2020; 158(5): 1232-1249.e3.
2. Heitmann PT, Vollebregt PF, Knowles CH, et al. Understanding the physiology of human defaecation and disorders of continence and evacuation. Nature Reviews Gastroenterology and Hepatology. Nature Research 2021;18(11):751–69.
3. Brandler J, Camilleri M. Pretest and Post-test Probabilities of Diagnoses of Rectal Evacuation Disorders Based on Symptoms, Rectal Exam, and Basic Tests: a Systematic Review. Clinical Gastroenterology and Hepatology 2020;18(11):2479–90.
4. Rao SSC, Bharucha AE, Chiarioni G, et al. Anorectal disorders. Gastroenterology. 2016;150(6):1430-1442.e4.
5. Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393-1407.e5.
6. Serra J, Pohl D, Azpiroz F, et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterology and Motility 2020;32(2).
7. Mearín F, Ciriza C, Mínguez M, et al. Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult. Rev Esp Enferm Dig 2016;108(6):332-63.
8. Bove A, Pucciani F, Bellini M, et al. Consensus statement AIGO/SICCR: Diagnosis and treatment of chronic constipation and obstructed defecation (part I: Diagnosis). World J Gastroenterol 2012;18(14):1555-64.
9. Mearin F, Ciriza C, Mínguez M, et al. Clinical practice guidelines: Irritable bowel syndrome with constipation and functional constipation in adults: Concept, diagnosis, and healthcare continuity. (Part 1 of 2). Aten Primaria 2017;49(1):42–55.
10. Nurko S, Scott SM. Coexistence of constipation and incontinence in children and adults. Best Pract Res Clin Gastroenterol 2011;25(1):29–41.
11. Deb B, Prichard DO, Bharucha AE. Constipation and Fecal Incontinence in the Elderly. Current Gastroenterology Reports 2020;22(11):54.
12. Serra J, Mascort-Roca J, Marzo-Castillejo M, et al. Guía de práctica clínica sobre el manejo del estreñimiento crónico en el paciente adulto. Parte 2: Diagnóstico y tratamiento. Gastroenterologia y Hepatologia 2017;40(4): 303–316.
13. Tantiphlachiva K, Rao P, Attaluri A, et al. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clinical Gastroenterology and Hepatology 2010;8(11):955–60.
14. Caetano AC, Santa-Cruz A, Rolanda C. Digital Rectal Examination and Balloon Expulsion Test in the Study of Defecatory Disorders: Are They Suitable as Screening or Excluding Tests? Canadian Journal of Gastroenterology and Hepatology 2016;2016:8654314.
15. Dainese R, Serra J, Azpiroz F, et al. Effects of physical activity on intestinal gas transit and evacuation in healthy subjects. American Journal of Medicine 2004;116(8):536–9.
16. Anti M, Pignataro G, Armuzzi A, et al. Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Hepatogastroenterology. 1998;45(21):727–32.
17. Lever E, Cole J, Scott SM, et al. Systematic review: The effect of prunes on gastrointestinal function. Alimentary Pharmacology and Therapeutics 2014;40(7):750–8.
18. Bijkerk CJ, Muris JWM, Knottnerus JA, et al. Systematic review: The role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary Pharmacology and Therapeutics 2004;19(3): 245–51.
19. Lee-Robichaud H, Thomas K, Morgan J, et al. Lactulose versus Polyethylene Glycol for Chronic Constipation. Cochrane Database of Systematic Reviews 2010; (7).
20. Dipalma JA, Deridder PH, Orlando RC, et al. A Randomized, Placebo-Controlled, Multicenter Study of the Safety and Efficacy of a New Polyethylene Glycol Laxative. Am J Gastroenterol. 2000 Feb;95(2):446-50.
21. Bharucha AE, Pemberton JH, Locke GR. American gastroenterological association technical review on constipation. Gastroenterology 2013;144(1):218–38.
22. Skardoon GR, Khera AJ, Emmanuel A V., Burgell RE. Review article: dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation. Aliment Pharmacol Ther. 2017;46(4):410-423.
23. Del Popolo G, Mosiello G, Pilati C, et al. Treatment of neurogenic bowel dysfunction using transanal irrigation: A multicenter Italian study. Spinal Cord 2008;46(7):517–22.
24. Podzemny V, Pescatori LC, Pescatori M. Management of obstructed defecation. World Journal of Gastroenterology 2015;21(4):1053–60.
25. Smith LE, Pfeifer J, Agachan F, Wexner SD. CURRENT STATUS Surgery for Constipation A Review. Dis Colon Rectum 1996;39(4):444-60.
26. Raahave D, Loud FB, Christensen E, et al. Scand J Gastroenterol 2010;45(5):592–602.
27. Drossman DA, Hasler WL. Rome IV - Functional GI disorders: Disorders of gut-brain interaction. Gastroenterology 2016;150(6):1257–61.
28. Liang J, Almario C V., Chey WD, et al.Prevalence and Burden of Illness of Rome IV Chronic Idiopathic Constipation, Opioid-Induced Constipation, and Opioid-Exacerbated Constipation in the United States. Am J Gastroenterol 2023;118(11):2033–40.
29. De Giorgio R, Zucco FM, Chiarioni G, et al. Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel. Advances in Therapy 2021;38(7): 3589–621.
30. Farmer AD, Drewes AM, Chiarioni G, et al. Pathophysiology and management of opioid-induced constipation: European expert consensus statement. United European Gastroenterology Journal 2019;7(1):7–20.
31. Keefer L, Drossman DA, Guthrie E, et al. Centrally mediated disorders of gastrointestinal pain. Gastroenterology 2016;150(6):1408–19.
32. Crockett SD, Greer KB, Heidelbaugh JJ, et al. American Gastroenterological Association Institute Guideline on the Medical Management of Opioid-Induced Constipation. Gastroenterology 2019;156(1):218–26.
33. Horrigan J, Bhumi S, Miller D, et al. Management of Opioid-induced Constipation in Older Adults. J Clin Gastroenterol 2023;57(1):39–47.
34. Viscusi ER. Clinical overview and considerations for the management of opioid-induced constipation in patients with chronic noncancer pain. Clinical Journal of Pain 2019;35(2):174–88.
35. Fordtran JS, Hofmann AF. Seventy Years of Polyethylene Glycols in Gastroenterology: The Journey of PEG 4000 and 3350 From Nonabsorbable Marker to Colonoscopy Preparation to Osmotic Laxative. Gastroenterology 2017 ;152(4):675-680.
36. Freedman MD, Schwartz HJ, Roby R, Fleisher S. Tolerance and efficacy of polyethylene glycol 3350/electrolyte solution versus lactulose in relieving opiate induced constipation: a double-blinded placebo-controlled trial. J Clin Pharmacol 1997;37(10):904–7.
37. Gudin J, Vu L, Ceschim MR, et al. Peripherally acting mu-opioid receptor antagonists for the treatment of opioid-induced constipation. Aliment Pharmacol Ther 2022;55 Suppl 2:S8–15.
38. Oriol AL, Cruz-Sequeiros C, Luque-Blanco A, Porta-Sales J. Peripheral acting Mu opioid receptor antagonists in the treatment of the opioid-induced constipation: Review. Revista de la Sociedad Española del Dolor 2020;27(1):37–49.
39. Informe de Posicionamiento Terapéutico de naldemedina (Rizmoic® ) en estreñimiento inducido por opioides: Ministerio de Sanidad, Consumo y Bienestar Social. Agencia Española de Medicamentos y Productos Sanitarios;2021.[https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/2021/IPT_16--Rizmoic.pdf?x43061.
40. Katakami N, Harada T, Murata T, et. Randomized phase III and extension studies: Efficacy and impacts on quality of life of naldemedine in subjects with opioid-induced constipation and cancer. Annals of Oncology 2018;29(6):1461–7.
41. Katakami N, Harada T, Murata T, et al. Randomized Phase III and Extension Studies of Naldemedine in Patients With Opioid-Induced Constipation and Cancer. J Clin Oncol [2017;35:3859–66.
42. Saito Y, Yokota T, Arai M, Tada Y, Sumitani M. Naldemedine in japanese patients with opioid-induced constipation and chronic noncancer pain: Open-label phase III studies. J Pain Res 2019;12:127–38.
Related articles
Citation tools
Serra J, Alcedo J, Barber C, Ciriza de los Ríos C. Review document of the Spanish Association of Neurogastroenterology and Motility on the management of opioid-induced constipation. 10242/2024


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 572 visits.
This article has been downloaded 146 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 05/01/2024

Accepted: 22/01/2024

Online First: 02/02/2024

Published: 09/10/2024

Article Online First time: 28 days

Article editing time: 278 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology