Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
GI Physiology Unit, University College London, London, UK.
Expert Rev Gastroenterol Hepatol. 2023 Jul-Dec;17(10):975-983. doi: 10.1080/17474124.2023.2267441. Epub 2023 Oct 24.
Opioid-induced constipation remains undertreated despite effective and safe treatment options exists. Previous guidelines have only been partially effective in improving management, possibly due to their complexity, and studies suggest that a simple setup of concise and behaviorally-orientated steps improves usability.
This article introduces the concept of opioid-induced constipation and provides an overview of existing guidelines in this field. We also propose simplified recommendations for managing opioid-induced constipation, derived from a synthesis of current guidelines and the principles of optimal guideline design theory.
Despite standard treatment with laxatives and fluid intake in patients with opioid-induced constipation, escalation of treatment is often needed where μ-opioid receptor antagonists or newer medications such as lubiprostone, linaclotide, or prucalopride are used. Previous guidelines have not been used sufficiently and thus management of the condition is often insufficient. We therefore propose simplified recommendations to management, which we believe can come into broader use. It was validated in primary care for credibility, clarity, relevance, usability, and overall benefit. We believe that this initiative can lead to better management of the substantial proportion of patients suffering from side effects of opioids.
尽管存在有效且安全的治疗方法，但阿片类药物引起的便秘仍未得到充分治疗。以前的指南在改善管理方面仅部分有效，这可能是由于其复杂性，并且研究表明，简单设置简洁且行为导向的步骤可以提高可用性。
本文介绍了阿片类药物引起的便秘的概念，并概述了该领域现有的指南。我们还提出了管理阿片类药物引起的便秘的简化建议，这些建议源自对当前指南和最佳指南设计理论原则的综合。
尽管对阿片类药物引起的便秘患者进行了标准的泻药和液体摄入治疗，但在需要使用μ-阿片受体拮抗剂或新型药物（如鲁比前列酮、利那洛肽或普芦卡必利）时，通常需要升级治疗。以前的指南没有得到充分利用，因此对这种情况的管理往往不足。因此，我们提出了简化的管理建议，我们相信这些建议可以得到更广泛的应用。它在初级保健中经过了可信度、清晰度、相关性、可用性和整体效益的验证。我们相信，这一举措可以改善大量遭受阿片类药物副作用影响的患者的管理。
