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Review
. 2025 Sep;20(6):1695-1704.
doi: 10.1007/s11739-025-04091-2. Epub 2025 Aug 28.

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

Piero Portincasa  1 , Chiara Valentina Luglio  2 , Silvia Sozzi  2 , Claudia Conforti  2 , Gianluca Bitonto  2 , Michele Papavero  2 , Gyorgy Baffy  3   4 , Agostino Di Ciaula  2
Affiliations
Review

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

Piero Portincasa et al. Intern Emerg Med. 2025 Sep.

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.

Keywords: Bristol stool scale; Gut transit; Laxatives; Naldemedine; Polyethylene glycol; Rome IV criteria.

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Conflict of interest statement

Declarations. Conflict of interest: All the authors report having no relevant conflicts of interest for this article. Human and animal rights statement and Informed consent: Not applicable

Figures

Fig. 1
Fig. 1
Chemical formulas of three PAMORAs: Methylnaltrexone, Naloxegol and Naldemedine
See this image and copyright information in PMC

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