Opioid-induced constipation in internal medicine: recognition and management pathways.

IF 3.8 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-08-28 DOI:10.1007/s11739-025-04091-2

Piero Portincasa, Chiara Valentina Luglio, Silvia Sozzi, Claudia Conforti, Gianluca Bitonto, Michele Papavero, Gyorgy Baffy, Agostino Di Ciaula

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Abstract

Opioid-induced constipation (OIC) remains one of the most frequent and distressing gastrointestinal side effects encountered by patients on chronic opioid therapy. Despite the high prevalence, OIC is frequently underdiagnosed and inadequately managed, with critical effects on the quality of life of patients. Aim of this review is to promote the awareness about OIC in the context of internal medicine. We examined the statement EnhanCing Healthcare Outcomes in Opioid-Induced Constipation (ECHO OIC) by European experts to streamline the diagnosis and management of OIC in clinical practice. Such guidelines have been further discussed by an Italian expert consensus to provide national customization and a multidisciplinary approach. The key finding is the implementation of a multi-step clinical pathway for prevention, diagnosis, treatment, and long-term management of OIC, taking into account the improvement of quality of life of patients. In conclusion, we urge to expand awareness about OIC. The seven-step diagnostic-therapeutic pathway approach formulated by ECHO OIC is a pragmatic and scalable model to improve OIC management with emphasis on education, early intervention, monitoring, tailored pharmacologic strategies, and coordinated referral when necessary.

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阿片类药物引起的便秘在内科：识别和管理途径。

阿片类药物引起的便秘（OIC）仍然是慢性阿片类药物治疗患者最常见和最痛苦的胃肠道副作用之一。尽管发病率很高，但OIC经常被误诊和管理不当，对患者的生活质量产生严重影响。这篇综述的目的是在内科背景下提高对OIC的认识。我们检查了欧洲专家的声明增强阿片类药物引起的便秘的医疗保健结果（ECHO OIC），以简化OIC在临床实践中的诊断和管理。意大利专家协商一致意见进一步讨论了这些准则，以提供国家定制和多学科方法。关键的发现是实施了一种多步骤的临床途径来预防、诊断、治疗和长期管理OIC，并考虑到患者生活质量的改善。最后，我们敦促扩大对伊斯兰会议组织的认识。ECHO OIC制定的七步诊断治疗路径方法是一种实用且可扩展的模式，可改善OIC管理，重点是教育，早期干预，监测，量身定制的药物策略，必要时协调转诊。

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来源期刊

Internal and Emergency Medicine 医学-医学：内科

CiteScore

7.20

自引率

4.30%

发文量

258

审稿时长

6-12 weeks

期刊介绍： Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.