Chronic Intestinal Pseudo-Obstruction: Diagnosis and Treatment

Colemont, Luc; Camilleri, Michael

doi:10.1016/s0025-6196(12)65304-x

Cited by 57 publications

(20 citation statements)

References 28 publications

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“…Our patient presented with chronic intestinal pseudoobstruction [6][7][8][9] . This is a rare condition characterized by recurrent episodes of intestinal obstruction in the absence of any mechanical defect.…”

Section: Diagnosismentioning

confidence: 99%

A Case of Chronic Intestinal Pseudo-Obstruction

Baichi¹

2003

TMF

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Section: Diagnosismentioning

confidence: 99%

A Case of Chronic Intestinal Pseudo-Obstruction

Baichi¹

2003

TMF

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“…26], This is an important observation as pa tients who have myopathic disease usually do not respond to prokinetic agents. However, those with neuropathic disease will usually show a response [6], In addition to defining the specific type of dysmotility pattern that is present, small bowel manometry may also help to differentiate mechanical obstruction from pseudo-obstruction [96].…”

Section: Antroduodenalmentioning

confidence: 99%

“…It is important to consider those con ditions that are reversible or respond fre quently to therapy. Some authors have di vided chronic intestinal pseudo-obstruction into myopathic and neuropathic categories, thereby providing a categorical approach, in sinuating a possible common abnormality de spite the numerous etiologies [5,6]. Colon, stomach, and esophagus may also be involved in some patients with intestinal pseudo-ob struction [7], Barium studies of the entire gas trointestinal tract are important to exclude mechanical obstruction and to help define the extent of disease [8].…”

Section: Introductionmentioning

confidence: 99%

Chronic Intestinal Pseudo-Obstruction

Verne

Sninsky

1995

Dig Dis

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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.

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“…Chronic intestinal pseudo-obstruction (CIP) may be broadly classified into myopathic and neuropathic forms. The latter may result from involvement of the myenteric plexus or from involvement of extrinsic autonomic innervation which spans the neural axis from the level of the brain to the postganglionic fibers [1]. Autonomic dysfunction has been infrequently studied in patients with CIP.…”

mentioning

confidence: 99%

Autonomic dysfunction in chronic intestinal pseudo-obstruction

Khurana

Schuster

1998

Clinical Autonomic Research

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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.

show abstract

Chronic Intestinal Pseudo-Obstruction: Diagnosis and Treatment

Cited by 57 publications

References 28 publications

A Case of Chronic Intestinal Pseudo-Obstruction

A Case of Chronic Intestinal Pseudo-Obstruction

Chronic Intestinal Pseudo-Obstruction

Autonomic dysfunction in chronic intestinal pseudo-obstruction

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