Chronic Intestinal Pseudo-Obstruction

Abstract

Chronic intestinal pseudo-obstruction denotes the clinical picture that results due to the failure of intestinal peristalsis to overcome the normal resistance to flow and is characterized by recurrent episodes of signs and symptoms of intestinal obstruction in the absence of any mechanical compromise of the intestinal lumen. The region(s) of the gut affected may be isolated or diffuse. It is not uncommon to find evidence of autonomic neuropathy and smooth muscle dysfunction with extraintestinal manifestations such as urinary symptoms from abnormal ureter or bladder function. Intestinal pseudo-obstruction can be caused by a variety of diseases, and for simplicity, certain authors have divided it into myopathic and neuropathic categories. Intestinal pseudo-obstruction may present at any age with a variable amount of abdominal pain, distension, nausea, diarrhea, or constipation and with laboratory abnormalities usually reflecting the degree of malabsorption and malnutrition present. The radiologic findings are varied but commonly include paralytic ileus or signs of apparent clinical obstruction with dilated loops of bowel. The number of pseudo-obstruction cases is dependent on how one defines the condition. It appears prudent to require radiographic abnormalities consistent with obstruction on a plain film of the abdomen for the diagnosis. More recently, studies have focused on the gastrointestinal manometric abnormalities of the stomach and small intestine in chronic intestinal pseudo-obstruction during fasting and fed states; however, sensitivity and specificity of these abnormalities are not well defined. Treatment is aimed at limiting symptoms and maintaining adequate nutrition. Prokinetic agents should be tried in an attempt to restore normal intestinal propulsion. However, their overall efficacy appears to be variable. It is still too premature to consider intestinal pacing or small bowel transplantation in this condition. Surgical approaches to chronic intestinal pseudo-obstruction should be limited to patients refractory to medical therapy, and even then, an approach focused on the patient’s primary presenting symptoms should be considered.

Chronic primary intestinal pseudo-obstruction from visceral myopathy

“…CIPO's association with other disorders suggesting an autonomic neuropathy or extraintestinal smooth muscle dysfunction, including urologic symptoms from ureteral or vesical dysfunction, is not a rare finding (41). The patient reported here had self-limited urinary incontinence during the pre-operative period, but the neurologic and urologic examination yielded normal results.…”

Chronic intestinal pseudo-obstruction: Report of two cases

“…Gastrointestinal system, smooth muscle, nervous system and endocrine system impairments, metabolic and autoimmune disorders, and infectious states (CMV, EBV, etc.) are among the secondary causes [1,7]. The disorder is termed as chronic idiopathic intestinal pseudo-obstruction (CIIP), should it not be attributed to any genetic or secondary cause [4].…”

“…Liquid foods should be given for a short period of time during symptomatic periods. Any vitamin and mineral deficiency should be corrected through supplementation [1]. Prokinetic agents can be utilized in the pharmacological treatment, yet metoclopramide and domperidone prove ineffective in the treatment.…”

“…Chronic intestinal pseudo-obstruction (CIPO) is a rare clinical syndrome of insufficient intestinal propulsion, which is characterized by symptoms and signs of bowel obstruction in the absence of any mechanical obstruction [1]. Although first defined by Dudley in [2,3] 1958, the term chronic intestinal pseudo-obstruction (CIPO) found a place in the literature in 1970.…”

Relationship Between Metabolic Parameters and Helicobacter Pylori Infections With Upper Gastrointestinal System Endoscopy and Gastric Histopathology Results in Patients With Dyspeptic Type 2 Diabetes Mellitus

“…Diyabetiklerin %75'inde diyabetik nöropatiye bağlı gastrointestinal semptomlar görülür. Gastrointestinal anormalliklerin, nöropatiye bağlı motor hastalık ve kan glikozu yüksekliğine bağlı metabolik bozuklukların kombinasyonu şeklinde ortaya çıktığı bildirilmektedir (18,19). Diyabetik olgularda HP'ye atfedilen gastroenterolojik patolojilerin ayrımı gerekmektedir.…”