Could Chronic Idiopatic Intestinal Pseudo-Obstruction Be Related to Viral Infections?

Abstract

Chronic idiopathic intestinal pseudo-obstruction (CIIPO) is a disease characterized by symptoms and signs of small bowel obstruction in the absence of displayable mechanical obstruction. Due to the known neuropathic capacity of several viruses, and their localization in the intestine, it has been hypothesized that such viruses could be involved in the pathogenesis of CIIPO. The most frequently involved viruses are John Cunningham virus, Herpesviridae, Flaviviruses, Epstein–Barr virus and Citomegalovirus. Therefore, the present narrative review aims to sum up some new perspectives in the etiology and pathophysiology of CIIPO.

The Potential Role of Microorganisms on Enteric Nervous System Development and Disease

“…The majority of PIPO cases exhibit neuropathic rather than myopathic disturbance, suggesting that the ENS is a key target [ 94 ]. In the adult counterpart of PIPO, chronic intestinal pseudo-obstruction (CIPO) there has been considerable and recent focus on the role of viral infections, with some experts proposing that a search for potential viral infections should be inherent to investigations in paediatric and adult cases [ 95 ]. The most common neuropathic viruses include human polyomavirus or JC virus, HSV, CMV, VZV, the Epstein–Barr virus (EBV), and Flaviviruses; several reports have revealed the DNA of these viruses within glial and neuronal cells of the myenteric plexus in the GI tract of patients with intestinal pseudo-obstruction [ 95 , 96 , 97 ].…”

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

“…In the current COVID pandemic world it is hard to ignore the potential for pathogens such as viruses to be involved in the etiopathogenesis of gut motility disorders. There has certainly been a significant and evolving recent focus on the role of viral infections in conditions such as chronic intestinal pseudo‐obstruction, with many experts in the field suggesting that it is mandatory to search for potential viral infections (reviewed in (10)). The most commonly implicated neuropathic viruses include human polyomavirus or John Cunningham virus, herpes simplex virus, Epstein‐Barr virus, cytomegalovirus, varicella‐zoster virus, and Flaviviruses, with the DNA of these viruses detected within glial and neuronal cells of the myenteric plexus in the small intestine and colon of patients with chronic intestinal pseudo‐obstruction (10).…”

“…There has certainly been a significant and evolving recent focus on the role of viral infections in conditions such as chronic intestinal pseudo‐obstruction, with many experts in the field suggesting that it is mandatory to search for potential viral infections (reviewed in (10)). The most commonly implicated neuropathic viruses include human polyomavirus or John Cunningham virus, herpes simplex virus, Epstein‐Barr virus, cytomegalovirus, varicella‐zoster virus, and Flaviviruses, with the DNA of these viruses detected within glial and neuronal cells of the myenteric plexus in the small intestine and colon of patients with chronic intestinal pseudo‐obstruction (10). In this context, with specific regards to children, the perinatal period incorporating maternal, congenital, and neonatal aspects provides a well‐recognized focus of neurotrophic pathogens capable of causing significant disease (eg, varicella, cytomegalovirus) (11,12).…”

Pediatric Intestinal Pseudo-Obstruction: Progress and Challenges

“…A trial of immunotherapy like high doses of intravenous steroids, intravenous immunoglobulins, or apheresis, should be considered in patients with a suspected AGID, especially if antineuronal antibodies are detected ( 15 , 17 , 54 ). Improvement with immunotherapy could also aid in the diagnosis of AGID ( 15 ).…”