Rome IV Diagnostic Criteria for Opioid-Induced Constipation
Official Rome IV criteria for the diagnosis of opioid-induced constipation.
Use in patients with symptoms suggestive of constipation in the setting of opioid use.
Patients with any of the following features must be evaluated clinically for other diagnoses even though opioid induced constipation may be present:
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Signs or symptoms of gastrointestinal bleeding.
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Unexplained iron deficiency anemia.
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Unintentional weight loss.
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Palpable abdominal mass or lymphadenopathy on exam.
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Family history of colon cancer and have not had age-appropriate colon cancer screening.
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Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.
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Sudden or acute onset of new change in bowel habit that occurred prior to initiation or dose change of an opioid.
If diagnosis not met (negative):
Symptoms unlikely to be caused by opioid induced constipation. Consider further assessment as clinically indicated.
If meets diagnosis (positive):
Likely diagnosis of opioid induced constipation. Consider initiating treatment.
Management of opioid induced constipation is often similar to management of functional constipation.
Treatment may include:
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Adequate dietary fiber intake and supplementation.
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Osmotic laxatives (e.g. PEG-3350, lactulose).
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Peripherally acting μ-opioid receptor antagonists (PAMORA) (e.g. naloxegol).
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Lubiprostone. Other secretagogues (e.g. linaclotide, plecanatide) may be considered.
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Stimulant laxatives (e.g. bisacodyl, senna) as a rescue medication.
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5-HT4 receptor agonist (e.g. prucalopride).
This calculator should only be used in patients where a secondary cause of constipation other than opioid use (e.g. mechanical obstruction, systemic illness, medications) is not suspected based on clinical history, physical exam and initial work-up.