Autonomic dysfunction in chronic intestinal pseudo-obstruction

Abstract

Fifteen tests were used to assess adrenergic, non-vagal cholinergic, and cardiovagal functions in 11 patients with chronic intestinal pseudo-obstruction (CIP). The three aims of this study were: 1) to ascertain the presence of and spectrum of autonomic involvement; 2) to assess the level of autonomic dysfunction; and 3) to compare the results of autonomic function tests with gastrointestinal motility patterns. Gastrointestinal motility displayed a neuropathic pattern in 10 patients. Adrenergic functions were abnormal in nine patients and non-vagal cholinergic functions in 10 patients. Cardiovagal functions were abnormal in only seven patients. The autonomic dysfunction was localized mostly to the postganglionic pathways. One patient, who had a myopathic pattern and muscle degeneration on small bowel biopsy, demonstrated normal responses to autonomic function tests. The patients with neuropathic CIP demonstrated widespread, mostly postganglionic autonomic dysfunction. Neuropathic CIP can occur with or without cardiovagal involvement.

Sympathetic Nerve Dysfunction is Common in Patients With Chronic Intestinal Pseudo-obstruction

“…24,25 The small or absent correlation could be due to the fact that the majority of patients included only had limited gastrointestinal disturbances, 22-25 as compared with severe cases in the current and other similar studies. 10,11 In agreement, patients with severe esophageal dysmotility have a high frequency of autonomic neuropathy, 26,27 whereas in patients with modest esophageal dysmotility no such correlation is noted. 28 In conclusion, simple autonomic nerve function tests may be useful to connect autonomic neuropathy to gastrointestinal dysmotility.…”

“…10,11 However, Camilleri et al 10 included many patients with gastrointestinal dysmotility secondary to diabetes mellitus, which may confuse the picture; parasympathetic nerve dysfunction is frequent in diabetic patients. 19 In our study, diabetic patients were in minority.…”

“…Our hypothesis was that these symptoms are expressions of neuropathy not only in the enteric nervous system, but also in other parts of the autonomic nervous system, as this has been described in some studies. 10,11 However, autonomic neuropathy is not described in the defined criteria for idiopathic intestinal pseudo-obstruction. 1,4 The aims of this study were to see whether there was any autonomous reflected by abnormal cardiovascular reflexes in our patients, and if so; to see if there were any correlations between disturbances in the autonomic nervous system and the symptoms of extreme coldness and sweating in patients with intestinal pseudoobstruction.…”

Ogilvie’s syndrome treated with an emergency laparotomy, right hemicolectomy and end ileostomy

“…Dysregulation of autonomic supply to the Auerbach and myenteric plexus precipitates failure of the physiological smooth muscle contractions of the small bowel and colon, thereby impairing normal gut peristalsis and predisposing the individual to ACPO 5. This proposed ‘neurogenic’ mechanism of pathogenesis helps to account for the frequent association of ACPO with primary neurological disease and comorbidities in which sensory, motor and autonomic neuropathy is a dominant component.…”

“…However, it fails to satisfactorily explain the prevalence of ACPO in other chronic systemic inflammatory disorders, autoimmunity and paraneoplastic syndromes. This affiliation may be explained by the presence of high antineuronal and anti-calcium channel antibodies generated as a product of such disease processes 5. Furthermore, the production of anti-smooth muscle antibodies observed in autoimmune and paraneoplastic phenomena causes visceral autonomic myopathy of the small bowel and colonic smooth muscle, leading to dysregulated peristalsis and predisposition to ACPO 6.…”