Hépato-Gastro & Oncologie Digestive
MENUOpioid-induced constipation Volume 27, issue 1, Janvier 2020
- Key words: opioid-induced constipation, bowel dysfunction, μ receptor, management algorithm, gastro-intestinal motility
- DOI : 10.1684/hpg.2019.1898
- Page(s) : 36-45
- Published in: 2020
Opioids use for pain has increased in recent years. Opioid-induced constipation (OIC) is the most common side effect on the gastrointestinal tract. Adverse event could lead to cessation of therapy. Elderly population is extremely exposed to OIC. Gastro-intestinal effect result on the activation of μ-receptors widely distributed throughout the gastro-intestinal tract. Opioids effects result on gastrointestinal dysmotility, decrease in chloride and water secretion in the lumen and dysfunction on gastrointestinal sphincters. CIO occurs or worsen after introduction of an opioid and is defined by ROME IV criteria. First of all, other aetiology has to be excluded. A digital rectal examination is strongly recommended to exclude anorectal pathologies. BFI and Bristol Stool Scale are validated questionnaires that can help physicians in clinical management. Management start with prophylactic treatment (fluid intake, activity, high fiber intake). Then management includes standard laxatives, such as osmotic agents and stimulants. In case of inefficacy, peripherally-acting μ-opioid receptor antagonist (PAMORAs) could be used. In France, naloxegol and methylnaltrexone could be used.