Impaired transit of chyme in chronic intestinal pseudoobstruction: Correction by cisapride

Abstract

Chronic intestinal pseudoobstruction is a clinical syndrome whose pathophysiology, objective diagnosis, and treatment are poorly understood. We investigated 8 patients with this syndrome in whom intestinal dysmotility was established manometrically by two or more of the following criteria: abnormal configuration or propagation of interdigestive motor complexes, sustained incoordinate pressure activity, nonpropagated bursts of phasic pressure activity, and failure of a solid-liquid meal to induce a fed pattern. To establish the functional impairment and region of the gut primarily affected by the disease, we quantified radioscintigraphically the gastrointestinal transit of the solid (131I-fiber) and liquid (99mTc-DTPA) components of a meal. Our techniques allowed us to quantify separately gastric emptying and pylorus-to-cecum transit. Furthermore, we evaluated the effects of a new prokinetic agent, cisapride. Gastric emptying times in pseudoobstruction were not significantly delayed; however, transit times through the small bowel (t1/2) were markedly prolonged [solids, 235 ± 43 min (mean ± SEM) vs. 138 ± 25 controls, p < 0.05; liquids, 310 ± 67 vs. 181 ± 28 controls, p = 0.07]. Cisapride was effective in reducing the delayed intestinal transit time to within the normal range (Δ solids = −115 ± 25 min; Δ liquids = −146 ± 71 min; p < 0.05 for both). These studies suggest that intestinal dysmotility in this group of patients with pseudoobstruction was associated with delayed small bowel transit of radiolabeled solid and liquid components of chyme. Cisapride can restore to normal the delayed transit, indicating that it may potentially correct the impaired propulsive activity in the small bowel of these patients.