[Chronic intestinal pseudo-obstruction].
Chronic intestinal pseudo-obstruction (CIPO) is a disease characterized by episodes resembling mechanical obstruction in the absence of organic, systemic, or metabolic disorders. Pseudo-obstruction is an uncommon condition and can result from primary (40%) or secondary (60%) causes. The most common symptoms are nausea, vomiting, abdominal distension, abdominal pain and constipation or diarrhea. These symptoms are usually present many years before CIPO diagnosis. They can lead to severe electrolyte disorders and malnutrition. Principles for management of patients with CIPO are: to establish a correct clinical diagnosis in excluding mechanical obstruction; to perform a symptomatic and physiologic assessment of the gastrointestinal tract involved; to look for extra-intestinal manifestations, especially for myopathy and neuropathy; to discuss in some cases a surgery for full-thickness intestinal biopsies, and/or a neuromuscular biopsy in case of mitochondrial cytopathy suspicion. The management is primarily focused on symptom control and nutritional support to prevent weight loss and malnutrition. Treatment of CIPO includes prokinetic agents which may help to reduce gastrointestinal symptoms Courses of antibiotics may be needed in patients with symptoms suggestive of bacterial overgrowth. When necessary, enteral nutrition is preferred. In carefully selected patients, feeding jejunostomy with or without decompression gastrostomy may be tried. Long term parenteral nutrition should be reserved for patients who can not tolerate enteral nutrition. Intestinal transplantation can be discussed in selected patients.
Joly
Francisca
F
Service de Gastroentérologie et d'Assistance nutritive, Hôpital Beaujon, 100 Boulevard du Général Leclerc, Clichy-la-Garenne, 92110 Clichy cedex.
Amiot
Aurélien
A
Coffin
Benoît
B
Lavergne-Slove
Anne
A
Messing
Bernard
B
Bouhnik
Yoram
Y
D002908:Chronic Disease; D018492:Dopamine Antagonists / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018529:Nutritional Support
D018492:Dopamine Antagonists; D005765:Gastrointestinal Agents