High density of µ-opioid receptors was found in neurons of the myenteric and submucosal plexus and immune cells in the lamina propria. It seems that the peripheral opioid effect on µ-opioid receptors in the gut wall plays the main role here, but the central effects are also important. Outline of pathomechanism of opioid-induced bowel dysfunction Approximately one third of patients treated with opioid analgesics does not adhere to the prescribed opioid regimen or simply quit the treatment due to OIBD symptoms. Opioid-induced bowel dysfunction also significantly deteriorates patients’ quality of life and compliance. Opioid-induced bowel dysfunction may lead to inappropriate opioid dosing and in consequence insufficient analgesia. In the case of long-term opioid therapy these symptoms may lead to the development of more serious complications such as bowel faecal impaction with overflow diarrhoea and faecal incontinence, pseudo-obstruction (which may cause anorexia, nausea and vomiting), disturbance of drug absorption, urine retention and urine incontinence. The OIBD comprises several symptoms including constipation, anorexia, nausea and vomiting, gastro-oesophageal reflux, delayed digestion, abdominal pain, flatulence, bloating, hard stool, straining during bowel movement and incomplete evacuation. Opioid-induced bowel dysfunction (OIBD) is a common adverse effects syndrome associated with the chronic use of opioid analgesics. These effects also appear in the gastrointestinal (GI) tract. However, apart from analgesia opioids exert numerous adverse effects which may limit their effectiveness and patients’ compliance. Opioid analgesics are commonly and in most cases effectively used in chronic pain management of moderate to severe intensity. Keywords: constipation, opioid analgesics, opioid-induced bowel dysfunction, opioid receptor antagonists, treatment Introduction The aim of this article is to review the pathomechanism and possible treatment strategies of OIBD. One is a combination of an opioid and opioid antagonist (oxycodone/naloxone) in prolonged-release tablets, and another is a purely peripherally acting opioid receptor antagonist (methylnaltrexone) available in subcutaneous injections. New therapies target opioid receptors in the gut that seem to be the main source of OIBD. Other possibilities comprise opioid switch or changing the administration route. Traditional oral laxatives are used but their effectiveness is limited and they display adverse effects. Several strategies are undertaken to prevent or treat OIBD. Approximately one third of patients treated with opioids do not adhere to the opioid regimen or simply quit the treatment due to OIBD. Opioid-induced bowel dysfunction (OIBD) comprises gastrointestinal symptoms such as constipation, anorexia, nausea, vomiting, gastro-oesophageal reflux, delayed digestion, abdominal pain, bloating, hard stool and incomplete evacuation that significantly deteriorate patients’ quality of life and compliance. This article has been cited by other articles in PMC.
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