Department of Internal Medicine, Park-Klinik Weissensee, Berlin, Germany.
Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Piazza Università, 1, Perugia, Italy.
Pain Med. 2017 Oct 1;18(10):1837-1863. doi: 10.1093/pm/pnw255.
To formulate timely evidence-based guidelines for the management of opioid-induced bowel dysfunction.
Constipation is a major untoward effect of opioids. Increasing prescription of opioids has correlated to increased incidence of opioid-induced constipation. However, the inhibitory effects of opioids are not confined to the colon, but also affect higher segments of the gastrointestinal tract, leading to the coining of the term "opioid-induced bowel dysfunction."
A literature search was conducted using Medline, EMBASE, and EMBASE Classic, and the Cochrane Central Register of Controlled Trials. Predefined search terms and inclusion/exclusion criteria were used to identify and categorize relevant papers. A series of statements were formulated and justified by a comment, then labeled with the degree of agreement and their level of evidence as judged by the Strength of Recommendation Taxonomy (SORT) system.
From a list of 10,832 potentially relevant studies, 33 citations were identified for review. Screening the reference lists of the pertinent papers identified additional publications. Current definitions, prevalence, and mechanism of opioid-induced bowel dysfunction were reviewed, and a treatment algorithm and statements regarding patient management were developed to provide guidance on clinical best practice in the management of patients with opioid-induced constipation and opioid-induced bowel dysfunction.
In recent years, more insight has been gained in the pathophysiology of this "entity"; new treatment approaches have been developed, but guidelines on clinical best practice are still lacking. Current knowledge is insufficient regarding management of the opioid side effects on the upper gastrointestinal tract, but recommendations can be derived from what we know at present.
制定针对阿片类药物引起的肠道功能障碍管理的及时循证指南。
便秘是阿片类药物的主要不良反应。阿片类药物处方的增加与阿片类药物引起的便秘的发生率增加相关。然而，阿片类药物的抑制作用不仅局限于结肠，还会影响胃肠道的更高段，从而产生了“阿片类药物引起的肠道功能障碍”这一术语。
使用 Medline、EMBASE 和 EMBASE Classic 以及 Cochrane 中央对照试验注册库进行文献检索。使用预设的搜索词和纳入/排除标准来识别和分类相关论文。制定了一系列陈述，并通过评论进行了论证，然后根据推荐分类（SORT）系统的同意程度和证据水平进行标记。
从 10832 篇潜在相关研究中列出了 33 篇引文进行审查。筛选相关论文的参考文献列表确定了其他出版物。审查了阿片类药物引起的肠道功能障碍的当前定义、流行率和机制，并制定了治疗算法和关于患者管理的陈述，以提供有关管理阿片类药物引起的便秘和阿片类药物引起的肠道功能障碍患者的临床最佳实践的指导。
近年来，我们对这种“实体”的病理生理学有了更多的了解；已经开发出了新的治疗方法，但仍缺乏关于临床最佳实践的指南。目前，我们对管理上消化道的阿片类药物副作用的了解还不够充分，但可以从目前所知的内容中得出建议。
