Opioid induced constipation (OIC)
THE BOWEL FUNCTION INDEX
BRISTOL STOOL CHART
The Bristol Stool Chart (BSC) is a visual aid to assist patients and healthcare practitioners identify constipation. There are 7 types of stool shown, with types 1 & 2 indicating constipation, 3 & 4 being the ideal stools (especially the latter) and 5, 6 & 7 tending towards diarrhoea. The harder stools of types 1 & 2 have been evidenced as having a longer whole-gut transit time (WGTT) while softer stools, those similar to 5, 6 & 7 have a shorter WGTT.2
This is a patient self-report tool for assessment of a patient’s experience of constipation over two weeks by measuring symptoms and symptom severity. It consists of 12 symptoms divided into three domains: abdominal, rectal and stool with responses rated on a 5-point Likert scale.3
This is the second of the two complementary PAC components designed to assess the impact of constipation on quality of life. It is a self-reported questionnaire consisting of 28 items grouped into four subscales.4 Patients are asked to recall the impact of constipation on their daily life over the past two weeks, and responses for each item range from 0 to 4 again.4,5
ROME IV CONSENSUS CRITERIA
Clinicians and patients tend to define constipation differently. To address this issue, an international panel of experts convened to develop the Rome IV criteria for the diagnosis of constipation.
According to the Rome IV criteria, OIC is present if patients report new or worsening of symptoms of constipation when initiating, changing or increasing opioid therapy that must include 2 or more of a pre-determined set of symptoms – this healthcare professional consultation guide provides a helpful overview of the new Rome IV criteria.6
References: 1. Ducrotté P, Caussé C. The Bowel Function Index: a new validated scale for assessing opioid-induced constipation. Current Medical Research and Opinion. 2012;28(3):457-466. 2. Lewis S, Heaton K. Stool Form Scale as a Useful Guide to Intestinal Transit Time. Scandinavian Journal of Gastroenterology. 1997;32(9):920-924. 3. Slappendel R, Simpson K, Dubois D, et al. Validation of the PAC-SYM questionnaire for opioid-induced constipation in patients with chronic low back pain. European Journal of Pain. 2006;10(3):209-217. 4. Hatswell A, Vegter S. Measuring quality of life in opioid-induced constipation: mapping EQ-5D-3 L and PAC-QOL. Health Economics Review. 2016;6(1):1-7. 5. Marquis P, De La Loge C, Dubois D, et al. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scandinavian Journal of Gastroenterology. 2005;40(5):540-551. 6. Simren M, Palsson O, Whitehead W. Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. Current Gastroenterology Reports. 2017;19(15):1-8.