Management Of Chronic Intestinal Pseudo-obstruction Research Articles

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

Chronic intestinal pseudo-obstruction (CIPO) and enteric dysmotility (ED) are small intestinal motility disorders defined by radiological and manometric criteria. In the absence of consensus guidelines, we surveyed opinions on the diagnosis and management of CIPO and ED among experts from different countries. A survey questionnaire was circulated electronically to members of the European society for Clinical Nutrition and Metabolism, European Society of Neurogastroenterology and Motility, and United European Gastroenterology. Only responses from participants completing all required components were included. Of 154 participants, 93% agreed that CIPO and ED should be classified separately. Overall, 73% reported an increasing incidence of CIPO and ED, with hypermobile Ehlers-Danlos Syndrome the group with the largest increase in referrals (37%), particularly in the UK (P<.0001). The majority (95%) find diagnosing CIPO and ED difficult. Notably, antroduodenal manometry, a test mandated to diagnose ED, is infrequently used (only 21% respondents use in >50% cases) and full thickness biopsies were reported to seldom influence medical treatment, nutritional management, and prognosis. Respondents reported that very few treatments are useful for most patients, with bacterial overgrowth treatment, prucalopride, and psychological therapies felt to be the most useful. While only 23% of clinicians felt that parenteral nutrition (PN) improves gastrointestinal symptoms in >50% of cases, 68% reported PN dependency at 5years in the majority of cases. These data highlight the difficulties with diagnosing and managing CIPO and ED and underscore the urgent need for international, multidisciplinary, clinical practice guidelines.

Diagnosis and Management of Chronic Intestinal Pseudo-Obstruction Secondary to Visceral Myopathy: A Case Presentation

Diagnosis and Management of Chronic Intestinal Pseudo-Obstruction Secondary to Visceral Myopathy: A Case Presentation

Pathophysiology, Diagnosis, and Management of Chronic Intestinal Pseudo-Obstruction.

Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder characterized by an impairment of coordinated propulsive activity in the gastrointestinal (GI) tract, which clinically mimics mechanical intestinal obstruction. CIPO is the most severe and debilitating form of GI dysmotility. CIPO may be primary or be secondary to pathology at any level of the brain-gut axis as well as systemic disease. The clinical features of CIPO are pleomorphic and largely depend on the site and extent of the segment of the GI tract involved. The diagnostic approach includes the need for investigations to exclude mechanical GI obstruction, screening for causes of secondary CIPO and the identification of the disease phenotype as well as the prompt recognition and treatment of complications such as malnutrition and small intestinal bacterial overgrowth. In managing this disorder, a holistic, multidisciplinary approach is needed with judicious use of pharmacotherapeutic agents. While currently there are no specific therapeutic modalities for CIPO, treatment is largely directed at maintaining adequate nutrition and electrolyte balance and enhancing coordinated GI motility. Surgery should be avoided unless advisable for carefully selected patients and may include stoma formation. This narrative review provides a concise overview of the literature on this rare, severe and complex disorder, and highlights the need and areas for further research to improve both diagnostics and therapeutics.

Nationwide survey on adult type chronic intestinal pseudo-obstruction in surgical institutions in Japan

No appropriate management of chronic intestinal pseudo-obstruction (CIP) has been established. The clinicopathological parameters of 103 cases collected by a nationwide questionnaire study were reviewed. The CIP cases were primary in 86 (83%) cases and secondary in 15 (15%) cases. The age of onset of the primary type was significantly younger than that of the secondary type (p=0.011). The diseased segments of the bowel were the large bowel in 60 (58%), the small bowel in 17 (17%), and both in 23 (22%) cases, respectively. Abdominal distension and pain were common symptoms regardless of the types of the diseased bowel; however, constipation was frequently seen in the large bowel type (p=0.0258). Vomiting and diarrhea were seen with marginally higher frequency in the small bowel type (p=0.0569, 0.0642). Surgical treatment was most effective in the large bowel type, less effective in the small bowel type, and least effective in the large and small bowel type. The prognosis of the primary CIP was significantly better than that of the secondary CIP (p=0.033). The segments of the diseased bowels should be considered in determining the indications for surgical treatments in CIP patients.

Nutritional management of chronic intestinal pseudo-obstruction.

Chronic intestinal pseudo-obstruction (CIP) is a gastrointestinal motility disturbance characterized by recurrent episodes of postprandial nausea and bloating in the absence of mechanical obstruction of the small bowel or colon. Weight loss and severe malnutrition are often seen in advanced stages of the disorder. This article discusses the nutritional management of patients with CIP, focusing on general dietary as well as enternal and parenternal nutritional support. Enteral access methods and various enteral formulas used in CIP are also discussed.

Audit of the Treatment of Malnutrition Due to Chronic Intestinal Pseudo‐Obstruction With Enteral Nutrition

Purpose: Chronic intestinal pseudo‐obstruction (CIP) can result in significant malnutrition and weight loss. Although parenteral nutrition can be a useful adjunct in the management of CIP, it is expensive and not without complications. Aim: To determine the outcome of enteral nutrition with nonelemental isotonic formulas in patients with CIP in a tertiary referral center, over the time period 1980 to 1998. Methods: A retrospective medical record review of patients with CIP receiving enteral nutrition. Median follow‐up was 3 years (range, 1 to 8 years) Results: 30 patients (20 women, 10 men; mean age at diagnosis, 49 years) with scleroderma (n = 10), amyloidosis (n = 10), and idiopathic CIP (n = 10) were studied. All had failed oral feeding and had a feeding tube placed. Jejunal tubes were placed in 19 patients and gastric tubes in 11 patients. Continuous feedings were used in 24 patients, and 6 patients received intermittent gravity feedings. Initially, the goal rate of delivery using a standard isotonic enteral formula (mean, 70 mL/h) was met in all patients. Hydration and body weights were maintained. Complications: Documented aspiration related to tube feeding occurred in 3 patients receiving gastric feeding and in none of the patients fed via the jejunal tube. Mild diarrhea occurred in 7 patients (4 jejunal fed and 3 gastric fed). At last follow‐up skin irritation of the tube site occurred in 3 patients with a surgically placed jejunal tube and 1 patient with a gastrostomy. At the time of the last follow‐up, 10 patients (scleroderma, n = 4; idiopathic pseudo‐obstruction, n = 5; amyloidosis, n = 1) developed worsening abdominal pain, were unable to meet their goal of formula delivery, and were placed on parenteral nutrition. These 30 patients were managed successfully on enteral nutrition for a mean of 2 years, (range, 1 to 8 years). Conclusions: Enteral nutrition with a standard nonelemental isotonic formula is a safe and effective means of nutrition delivery in patients with CIP who fail oral intake. Jejunal feeding using a continuous infusion is associated with less complications and is the preferred route of nutritional delivery in CIP.

Audit of the nutritional management of chronic intestinal pseudo-obstruction with tube feedings

Audit of the nutritional management of chronic intestinal pseudo-obstruction with tube feedings