Incidence, Prevalence, and Management of Opioid Bowel Dysfunction

• Published in: The American journal of surgery Vol. 182; no. 5; pp. S11 - S18
• Main Author: Pappagallo, Marco
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2001; Elsevier; Elsevier Limited
• Subjects: Analgesia; Analgesics, Opioid - adverse effects; Biological and medical sciences; Body mass index; Cancer; Cancer therapies; Cathartics - therapeutic use; Central nervous system; Colic - chemically induced; Constipation; Constipation - chemically induced; Constipation - drug therapy; Constipation - epidemiology; Data Collection; Drug toxicity and drugs side effects treatment; Gastroesophageal reflux; Gastroesophageal Reflux - chemically induced; Gastrointestinal tract; Humans; Incidence; Intestine; Intestines - drug effects; Intestines - physiopathology; Laxatives; Medical sciences; Morphine; Motility; Naloxone; Naltrexone - analogs & derivatives; Naltrexone - therapeutic use; Narcotic Antagonists - therapeutic use; Narcotics; Nervous system; Nitric oxide; Opioid receptors; Pain; Pain perception; Pathophysiology; Pharmacology. Drug treatments; Prevalence; Quality of life; Quaternary Ammonium Compounds; Receptors; Signs and symptoms; Therapy; Toxicity: digestive system; United States - epidemiology; United States > US; Human; Chemotherapy; Analgesic; Treatment; Pathophysiology; Dysfunction; Gut; Secondary effect; Digestive diseases; Intestinal disease; Opiates; Incidence
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(01)00782-6

Opioid bowel dysfunction (OBD) is a common adverse effect associated with opioid therapy. OBD is commonly described as constipation; however, it is a constellation of adverse gastrointestinal (GI) effects, which also includes abdominal cramping, bloating, and gastroesophageal reflux. The mechanism for these effects is mediated primarily by stimulation of opioid receptors in the GI tract. In patients with pain, uncontrolled symptoms of OBD can add to their discomfort and may serve as a barrier to effective pain management, limiting therapy, or prompting discontinuation. Patients with cancer may have disease-related constipation, which is usually worsened by opioid therapy. However, OBD is not limited to cancer patients. A recent survey of patients taking opioid therapy for pain of noncancer origin found that approximately 40% of patients experienced constipation related to opioid therapy (<3 complete bowel movements per week) compared with 7.6% in a control group. Of subjects who required laxative therapy, only 46% of opioid-treated patients (control subjects, 84%) reported achieving the desired treatment results >50% of the time. Laxatives prescribed prophylactically and throughout opioid therapy may improve bowel movements in many patients. Nevertheless, a substantial number of patients will not obtain adequate relief of OBD because of its refractory nature. Naloxone and other tertiary opioid receptor antagonists effectively reduce the symptoms of constipation in opioid-treated patients. However, because they also act centrally, they may provoke opioid withdrawal symptoms or reverse analgesia in some patients. There are 2 peripherally selective opioid receptor antagonists, methylnaltrexone and ADL 8-2698 (Adolor Corporation, Exton, PA, USA), that are currently under investigation for their use in treating OBD. Early studies confirm that they are effective at normalizing bowel function in opioid-treated patients without entering the central nervous system and affecting analgesia. With a better understanding of the prevalence of OBD and its pathophysiology, a more aggressive approach to preventing and treating OBD is possible and will likely improve the quality of life of patients with pain.