title: Frequency of mitochondrial defects in patients with chronic intestinal pseudo-obstruction.
abstract: OBJECTIVE
  Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder caused by intestinal dysmotility and characterized by chronic symptoms suggesting bowel obstruction in the absence of fixed, occluding lesions. CIPO has been associated with primary defects of the mitochondrial oxidative phosphorylation pathway, although the frequency of mitochondrial disorders in patients with CIPO is unknown. This study evaluates mitochondrial function in patients with CIPO.
  
  
  METHODS
  A retrospective study was performed of data collected from 80 CIPO patients at a tertiary centre over a 25-year period. Mitochondrial disorders were detected by analysis of serum lactate and thymidine phosphorylase activities, brain magnetic resonance images, and muscle biopsies. Genes encoding thymidine phosphorylase, mitochondrial DNA tRNA(leu(UUR)) or tRNA(lys), and DNA polymerase-gamma were analyzed for mutations.
  
  
  RESULTS
  Mitochondrial defects were identified in 15 patients (10 women; median age at diagnosis 32 years), representing 19% of the study cohort. All 15 patients had extra-digestive symptoms, 5 had mutations in the thymidine phosphorylase gene, 2 had mutations in tRNA(leu(UUR)), and 5 had mutations in the DNA polymerase-gamma gene. No genetic defect was detected in 3 of the patients with mitochondrial disorders. Patients with mitochondrial CIPO differed from patients without mitochondrial defects in their very severe nutritional status (frequent and long-term requirement for parenteral nutrition) and poor prognosis (frequent digestive and neurologic complications that led to a high incidence of premature death).
  
  
  CONCLUSIONS
  Mitochondrial disorders seem to be an important cause of CIPO. Patients with CIPO, especially severe cases with associated neurologic symptoms, should be tested for mitochondrial defects.
authors.affiliation: AP-HP, Hôpital Beaujon, Pôle des maladies de l'appareil digestif, Service de Gastroentérologie et d'assistance nutritive, Clichy, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Amiot
authors.forename: Maya
authors.initials: M
authors.lastname: Tchikviladzé
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
authors.forename: Abdelhamid
authors.initials: A
authors.lastname: Slama
authors.forename: Dominique Cazals
authors.initials: DC
authors.lastname: Hatem
authors.forename: Claude
authors.initials: C
authors.lastname: Jardel
authors.forename: Bernard
authors.initials: B
authors.lastname: Messing
authors.forename: Anne
authors.initials: A
authors.lastname: Lombès