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First Ever Consensus on the Management of Opioid-Induced Constipation Published in UEG Journal

LONDON, February 6, 2019 /PRNewswire/ --

  • For the first time, clinicians in Europe have access to a peer-reviewed, pragmatic guide to day-to-day clinical practice in the recognition and management of Opioid-Induced Constipation (OIC) 
  • New treatment algorithm set to change the management of Opioid-Induced Constipation and improve outcomes for patients 

Kyowa Kirin International PLC announced today the publication of Pathophysiology and Management of Opioid-Induced Constipation: European Expert Consensus Statement in United European Gastroenterology (UEG) Journal.[1]

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The European Consensus Statement was initiated to address the barriers to Opioid-Induced Constipation (OIC) diagnosis and to develop a pragmatic, stepwise approach to OIC management. OIC is currently an under-recognised and undertreated complication of opioid therapy, occurring in 51-87% of patients receiving opioids for cancer and around half (41-57%) of patients receiving opioids for chronic non-cancer pain.[1],[2],[3]

Dr Adam Farmer, lead author of the report and Consultant Gastroenterologist, University Hospitals of North Midlands NHS Trust said, "The consensus statement is a real step forward in terms of our understanding of opioid-induced constipation. For the first time we have a clinically relevant paper that brings together multiple strands of knowledge and will hopefully change clinical practice in years to come."

Dr Farmer continued, "The consensus statement is important for three reasons: firstly, for the identification of opioid-induced constipation, secondly for assessing and managing the problem and thirdly to guide appropriate treatment."

Effective management of OIC requires early recognition but patients' reluctance to report symptoms means the condition often goes unrecognised.[4] OIC is specifically caused by opioids binding to mu-receptors in the bowel and requires different treatment to other types of constipation as over half (54%) of patients with OIC don't respond to laxatives.[4],[5] Despite the availability of other treatment options, effective management is often not instituted and as a result, almost 60% of patients with OIC reduce their pain medication due to constipation.[6]

Speaking about what the publication means for patients, Professor Bart Morlion, Anaesthesiologist and President of the European Pain Federation (EFIC) said, "Opioid-induced constipation has a significant impact on a patient's quality of life, yet in many cases it remains an unreported side-effect".

"As a result, patients often attempt to alleviate their OIC symptoms by decreasing the dose or stopping their pain medication altogether. We hope the consensus statement will lead to better recognition of OIC and make a positive impact on the lives of patients affected by this condition."

"The consensus statement will improve doctors' knowledge and in turn, their understanding about how best to treat the condition."

The European Consensus Statement and development of an Opioid-Induced Constipation (OIC) management algorithm is the first to address the barriers to OIC diagnosis, including lack of awareness among clinicians about OIC in patients on opioid therapy, low use of universal diagnostic criteria and limited standard protocols for OIC management.[4]

The initiative, supported by Kyowa Kirin International PLC, was driven by a panel of experts from Europe, in the fields of neurogastroenterology, gastroenterology, pain medicine, palliative medicine and oncology, who conducted a focused review of the pathophysiology and clinical evaluation of OIC, which helped form the Consensus Statement.[1]

The Consensus Statement makes specific recommendations for the management of OIC, including educating patients about the side effects of opioids, co-prescription of a laxative, dietary and lifestyle modifications, asking patients about side-effects (including constipation at every clinical review), use of opioid antagonists and evaluation of gastrointestinal physiology.

Notes to Editors 

About Kyowa Kirin International PLC 

Kyowa Hakko Kirin Co., Ltd. is a research-based life sciences company, with special strengths in biotechnologies. In the core therapeutic areas of oncology, nephrology and immunology/allergy, Kyowa Hakko Kirin leverages leading-edge biotechnologies centred on antibody technologies, to continually discover innovative new drugs and to develop and market those drugs worldwide. In this way, the company is working to realise its vision of becoming a Japan-based global specialty pharmaceutical company that contributes to the health and wellbeing of people around the world.

Kyowa Kirin International PLC is a wholly owned subsidiary of Kyowa Hakko Kirin and is a rapidly growing specialty pharmaceutical company engaged in the development and commercialization of prescription medicines for the treatment of unmet therapeutic needs in Europe and the United States. Kyowa Kirin International PLC is headquartered in Scotland.

You can learn more about the business at:


  1. Farmer A, Drewes AM, Chiarioni G, et al. Pathophysiology and management of opioid-induced constipation: European expert consensus statement. United European Gastroenterology February 2019; 7: 7-20.
  2. Tuteja AK, Biskupiak J, Stoddard GJ, et al. Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil 2010; 22: 424-430, e496. 2010/01/27. DOI: 10.1111/j.1365-2982.2009.01458.x.
  3. Drewes AM, Munkholm P, Simren M, et al. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction-Recommendations of the Nordic Working Group. Scand J Pain 2016; 11: 111-122. 2016/04/01. DOI: 10.1016/j.sjpain.2015.12.005.
  4. Nelson AD, Camilleri M. Ther Adv Chronic Dis 2016;7:121-34
  5. Pappagallo M. Incidence, prevalence, and management of opioid bowel dysfunction. The American Journal of Surgery. 2001;182(5A Suppl):11S-18S.  
  6. Epstein R, Cimen A, Benenson H, et al. Patient preferences for change in symptoms associated with opioid-induced constipation. Advances in Therapy. 2004;31(12):1263-1271.

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Last Updated: 06-Feb-2019