title: Opioid-Induced Constipation and Bowel Dysfunction: A Clinical Guideline.
abstract: OBJECTIVE
  To formulate timely evidence-based guidelines for the management of opioid-induced bowel dysfunction.
  
  
  METHODS
  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."
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Park-Klinik Weissensee, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Müller-Lissner
authors.affiliation: Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Piazza Università, 1, Perugia, Italy.
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.affiliation: AP-HP Hôpital Louis Mourier, University Denis Diderot-Paris 7, INSERM U987, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Coffin
authors.affiliation: Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Asbjørn Mohr
authors.initials: AM
authors.lastname: Drewes
authors.affiliation: Department of Pain Management and Research, University of Oslo, Rikshospitalet, Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Breivik
authors.affiliation: Institute of Pain Medicine, Rambam Health Care Campus, The Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Elon
authors.initials: E
authors.lastname: Eisenberg
authors.affiliation: GI Physiology Unit, University College Hospital, Queen Square, London, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Emmanuel
authors.affiliation: Saint-Antoine University Hospital, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Laroche
authors.affiliation: Jena University Hospital, Jena, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.affiliation: The Leuven Center for Algology and Pain Management, University of Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Morlion
mesh_terms: D000465:Algorithms; D000701:Analgesics, Opioid / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced* / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007420:Intestine, Large / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid
keywords: Constipation; Laxatives; Opioid Antagonists; Opioids; PAMORAs