An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo‐obstruction and enteric dysmotility

Vasant, Dipesh H.; Pironi, Loris; Barbara, Giovanni; Bozzetti, Federico; Cuerda, Cristina; Joly, Francisca; Mundi, Manpreet S.; Paine, Peter; Staun, Michael; Szczepanek, Kinga; Gossum, A. Van; Wanten, Geert; Lal, Simon

doi:10.1111/nmo.13937

Cited by 15 publications

(50 citation statements)

References 35 publications

(82 reference statements)

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“…A multidisciplinary team is recommended for the management of CIPO, including the surgeon, gastroenterologist, and nutritionist [ 11 ]. These patients require supplemental nutritional support.…”

Section: Discussionmentioning

confidence: 99%

Chronic Intestinal Pseudo-Obstruction in a Young Male With Alcohol Abuse Disorder

Haider

Mehershanhi

Siddiqa

et al. 2021

Cureus

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Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome associated with significant mortality and morbidity. It mimics the signs and symptoms of intestinal obstruction in the absence of an anatomic lesion causing obstruction. Here we present a case of a young male with severe alcohol abuse disorder who initially presented with signs and symptoms of alcohol withdrawal but was found to have abdominal distension. Imaging studies revealed severe small and large bowel dilatation without any organic lesion. He continued to have marked intestinal dilatation for the subsequent few months. Alcohol cessation eventually led to a marked reduction in his symptoms and a decrease in intestinal dilatation. The occurrence of CIPO because of alcohol abuse is rare, and we explore the possible association between the two entities.

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Section: Discussionmentioning

confidence: 99%

Chronic Intestinal Pseudo-Obstruction in a Young Male With Alcohol Abuse Disorder

Haider

Mehershanhi

Siddiqa

et al. 2021

Cureus

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“…13,14 In a recent international survey on severe gastrointestinal dysmotility, in the majority of clinicians' practice, CIPO makes up to ≤25% of new referrals seen. 5 In contrast to CIPO, ED refers to patients with objective evidence of impaired small bowel contractility on antroduodenal manometry (ADM), but without a dilated intestine on radiological investigations. 1,15 Whilst the clinical significance of a manometric ED diagnosis remains controversial, there is increasing recognition amongst clinicians that CIPO is a distinct, and prognostically important phenotype, that should be recognized separately in patients with suspected dysmotility.…”

Section: Advances In the Diagnosis And Classification Of Gastrointestmentioning

confidence: 99%

“…1,15 Whilst the clinical significance of a manometric ED diagnosis remains controversial, there is increasing recognition amongst clinicians that CIPO is a distinct, and prognostically important phenotype, that should be recognized separately in patients with suspected dysmotility. 5 CIPO has been shown to be associated with worse outcomes including chronic intestinal failure, higher mortality and complications including small intestinal bacterial overgrowth, and the need for surgical interventions. 4,16,17 Therefore, radiological imaging to evaluate intestinal calibre, flow of contrast and exclude mechanical lesions is essential in the diagnosis.…”

Section: Advances In the Diagnosis And Classification Of Gastrointestmentioning

confidence: 99%

“…Other limitations of ADM include variability in results, difficulty in interpretation, poor correlation with symptoms and histopathology, and apparent limited impact on patient management, as well as lack of availability. 5,13,15,16,[18][19][20] These difficulties result in ADM being infrequently used, with only 21% of clinicians with an interest in severe gastrointestinal motility requesting the test in >50% of cases. 5 Wireless motility capsule (WMC), is a minimally invasive test which provides segmental, and whole gut transit times using pressure, pH and temperature sensors during its transit through the gastrointestinal tract, which can be helpful in evaluating small bowel transit.…”

Section: Advances In the Diagnosis And Classification Of Gastrointestmentioning

confidence: 99%

“…[1][2][3][4] However, until recently, in the absence of consensus guidelines, the diagnosis and management of severe gastrointestinal motility has remained contentious, and a recent international census of experts in the field has revealed a variation in practice. 5 Moreover, severe gastrointestinal dysmotility appears to be an increasingly common cause for referral to intestinal failure centres, accounting for up to 18% of adults requiring long-term parenteral nutrition (PN), with suggestion that the numbers referred for this indication may be increasing. [5][6][7][8][9] The aims of this paper are, therefore, to review current understanding and recent advances on the diagnosis and management of severe gastrointestinal dysmotility, the potential impact of recently published clinical practice guidelines, 10 and to highlight areas for future research.…”

Section: Introductionmentioning

confidence: 99%

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Recent Advances in the Management of Severe Gastrointestinal Dysmotility

Vasant

Lal

2021

CEG

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Severe gastrointestinal motility disorders with small bowel involvement continue to pose a major clinical challenge to clinicians, particularly because of the limitations of diagnostic tests and the lack of efficacious treatment options. In this article, we review current understanding and the utility of diagnostic modalities and therapeutic approaches, and describe how their limitations may potentially exacerbate prolonged suffering with debilitating symptoms, diagnostic delays, the risk of iatrogenic harm and increased healthcare utilisation in this group of patients. Moreover, observations from intestinal failure units worldwide suggest that this problem could be set to increase in the future, with reported trends of increasing numbers of patients presenting with nutritional consequences. Unfortunately, until recently, there has been a lack of consensus recommendations and guidance to support clinicians with their management approach. The aim of this narrative review is to summarise recent developments in this field following publication of an international census of experts, and subsequent clinical guidelines, which have emphasized the importance of holistic, multidisciplinary care. This is particularly important in achieving good clinical outcomes and ensuring the appropriate use of artificial nutritional support, in order to prevent iatrogenic harm. We discuss how these recent developments may impact clinical practice by supporting the development of specialised clinical services to deliver optimal care, and highlight areas where further research is needed.

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Medication use in a cohort of adults with chronic intestinal failure: A prospective cross‐sectional study

Deleenheer,

Lauwers,

Spriet

et al. 2023

Nut in Clin Prac

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BackgroundOral drug therapy may be compromised in chronic intestinal failure (IF) because of alterations in absorption and transit. Only scarce literature is available on which medication patients with chronic IF take in daily life. The aim was to describe the medication use in these patients.MethodsA medication history was obtained from adults with chronic IF treated in our tertiary care IF center. Degree of polypharmacy, drug classes, Biopharmaceutics Classification System classes, route of administration, and formulation of drugs were analyzed.ResultsFrom October 2019 until December 2020, 72 patients (35 patients with short bowel syndrome [SBS] and 37 patients without SBS) were included. Polypharmacy was seen in 85.7% of patients with SBS and 75.7% of patients without SBS. The top three drug classes were proton‐pump inhibitors, vitamin D or acetaminophen, and antimotility medication or laxatives/benzodiazepines. Approximately 25% of the drugs were classified as Biopharmaceutics Classification System class I drugs. In patients with SBS (78%) and patients without SBS (74.9%), most medication was taken orally, requiring gastrointestinal absorption of the active substance to be pharmacologically active. Most of these medications (77% in patients with SBS and 80.8% in patients without SBS) were formulated as a capsule or tablet, requiring disintegration and dissolution in the gastrointestinal tract before absorption can take place.ConclusionPolypharmacy was observed in most patients with chronic IF. Most medication was taken orally in formulations requiring disintegration, dissolution, and gastrointestinal absorption, which could be compromised in chronic IF.

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An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo‐obstruction and enteric dysmotility

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 15 publications

References 35 publications

Chronic Intestinal Pseudo-Obstruction in a Young Male With Alcohol Abuse Disorder

Chronic Intestinal Pseudo-Obstruction in a Young Male With Alcohol Abuse Disorder

Recent Advances in the Management of Severe Gastrointestinal Dysmotility

Medication use in a cohort of adults with chronic intestinal failure: A prospective cross‐sectional study

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