Institute of Applied Clinical Science, Keele University, Keele, UK.
Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
United European Gastroenterol J. 2019 Feb;7(1):7-20. doi: 10.1177/2050640618818305. Epub 2018 Dec 14.
Opioid-induced bowel dysfunction is a complication of opioid therapy, in which constipation is the most common and problematic symptom. However, it is frequently under-recognised and thus effective management is often not instituted despite a number of treatment options.
The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid-induced constipation and to provide a pragmatic management algorithm for day-to-day clinical practice.
This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature.
The pathophysiology of opioid-induced constipation is multi-faceted. The key aspect of managing opioid-induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid-induced constipation and monitoring response. Second-line treatments can be considered in those with recalcitrant symptoms, which include gut-restricted or peripherally acting mu-opioid receptor antagonists. However, a combination of interventions may be needed.
Opioid-induced constipation is a common, yet under-recognised and undertreated, complication of opioid therapy. We provide a pragmatic step-wise approach to opioid-induced constipation, which should simplify management for clinicians.
阿片类药物引起的肠功能障碍是阿片类药物治疗的一种并发症，其中便秘是最常见和最成问题的症状。然而，尽管有许多治疗选择，它常常被低估，因此有效的治疗措施往往没有实施。
本研究的主要目的是总结阿片类药物引起的便秘的病理生理学和临床评估，并为日常临床实践提供一个实用的管理算法。
本总结和治疗算法是基于评估文献中当前证据的欧洲专家小组的意见。
阿片类药物引起的便秘的病理生理学是多方面的。管理阿片类药物引起的便秘的关键是早期识别。具体的管理包括增加液体摄入、运动和标准的泻药，以及解决加重因素。肠道功能指数是一种评估阿片类药物引起的便秘严重程度和监测反应的有用方法。对于那些有顽固性症状的患者，可以考虑二线治疗，包括肠道限制或外周作用的μ-阿片受体拮抗剂。然而，可能需要组合干预措施。
阿片类药物引起的便秘是阿片类药物治疗的一种常见但被低估和治疗不足的并发症。我们提供了一种实用的逐步方法来处理阿片类药物引起的便秘，这应该可以简化临床医生的管理。
