Opioids are potent analgesics associated with substantial clinical burden and side effects, including those arising in the gastrointestinal tract. Opioid-induced bowel dysfunction (OIBD) encompasses symptoms including nausea, vomiting and opioid-induced constipation (OIC): the most common, yet under-recognised, OIBD subtype that can substantially impact patient quality of life, healthcare utilisation and workplace productivity. A consensus was sought on clinical recommendations to inform OIC management in clinical practice. A panel of European experts in neurogastroenterology, pain medicine and palliative medicine, chosen based upon their clinical and academic experience, met to discuss, develop and agree on the contents of the European Expert Consensus Statement and associated recommendations. The Expert Panel suggest a pragmatic stepwise management scheme for OIC management that is tailored to individual patients and their clinical presentation. Confirming the aetiology of constipation will inform on the approach: diagnosis of OIC requires initiation of a peripherally-acting μ-opioid receptor antagonist (PAMORA) or other opioid antagonist. Depending on treatment outcomes, referral to specialist/secondary care may be necessary. Regular clinical re-evaluation should be undertaken, and the Bowel Function Index (BFI) can also be used as a useful adjunct for diagnosis and monitoring. Successful OIC management is dependent on early recognition. The BFI is a useful way of objectively evaluating OIC severity and monitoring response. Optimal OIC management should be based on a stepwise approach. Treatments including PAMORAs need to be considered in those with recalcitrant symptoms, with an aim to improving patient outcomes in OIC.

PATHOPHYSIOLOGY AND MANAGEMENT OF OPIOID-INDUCED CONSTIPATION: EUROPEAN EXPERT CONSENSUS STATEMENT