Chronic intestinal pseudo-obstruction

Abstract

Chronic intestinal pseudo-obstruction (CIP) is a gastrointestinal motility disorder characterized by chronic symptoms and signs of bowel obstruction in the absence of a fixed, lumen-occluding lesion. Radiographic findings consist of dilated bowel with air-fluid levels. Pseudo-obstruction is an uncommon condition and can result from primary or secondary causes. The management is primarily focused on symptom control and nutritional support to prevent weight loss and malnutrition. The principles of management of patients with CIP involve 1) establishing a correct clinical diagnosis and excluding mechanical obstruction; 2) differentiating between idiopathic and secondary forms; 3) performing a symptomatic and physiologic assessment of the parts of the gastrointestinal (GI) tract involved by manometric and whole gut transit scintigraphic studies; 4) careful assessment of nutritional status of the patient; and 5) developing a therapeutic plan addressing the patient's symptoms and nutritional status. Treatment of CIP includes frequent small meals with a low-fat, low-fiber diet, liquid nutritional supplements may be needed; prokinetic agents such as metoclopramide may help to reduce upper GI symptoms. Trials of drugs such as erythromycin, domperidone, cisapride, and tegaserod may be considered if there is no response. Subcutaneous octreotide may be helpful to improve small bowel dysmotility especially in patients with scleroderma. In patients with symptoms suggestive of bacterial overgrowth, courses of antibiotics such as metronidazole, ciprofloxacin, and doxycycline may be needed. Nutritional assessment and support is an important aspect of management. Enteral nutrition is usually preferred. In carefully selected patients, feeding jejunostomy with or without decompression gastrostomy may be tried. Long term parenteral nutrition should be reserved for patients who can not tolerate enteral nutrition. Complications associated with total parenteral nutrition include infections, sepsis, and cholestatic hepatic dysfunction.

Chronic primary intestinal pseudo-obstruction from visceral myopathy

“…Chronic intestinal pseudo-obstruction (CIPO) is an uncommon, high-morbidity syndrome that develops as a consequence of altered intestinal motility, which results in clinical manifestations that resemble intestinal obstruction but in the absence of any obstructive process (1)(2)(3). It may be primary, when it exclusively involves intestinal smooth muscle or enteric neural plexa, or secondary to other conditions.…”

Serial Frozen Fecal Microbiota Transplantation in the Treatment of Chronic Intestinal Pseudo-obstruction: A Preliminary Study

“…20 Hence, the goals of treatment include control of symptoms, enhancement in nutritional status, improvement of nutritional status, and maintenance of quality of life. 21,22 The etiology of primary CIPO is varied. Abnormalities of smooth muscle cells, interstitial cells of Cajal, intrinsic (enteric) and extrinsic neural supplies, and the central nervous system may all play a role in the pathophysiology of CIPO whether separately or in various combinations.…”

Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

“…In such cases, a rapid increase of enteral nutrient after PEG may be responsible for the recurrent paralytic ileus. When there is coadministration of enterokinesis activators or gradual increases of enteral nutrients, this may prevent such recurrences [22,23] . In cases with chronic renal dysfunction, an aggravation of renal dysfunction or heart failure accounted for about 60% of the causes.…”