From the Guidelines
Chronic intestinal pseudoobstruction (CIPO) management should prioritize a multidisciplinary approach, focusing on symptom management, nutritional support, and addressing underlying causes, with the goal of improving quality of life and reducing morbidity and mortality. The condition is characterized by symptoms of intestinal obstruction without any physical blockage, resulting from abnormalities in the nerves, muscles, or interstitial cells of Cajal that control intestinal motility. Treatment options include:
- Medications such as prokinetics like metoclopramide or erythromycin, antiemetics like ondansetron, and pain management with non-narcotic options when possible, as opioids can worsen motility 1
- Nutritional support with a low-fiber diet, small frequent meals, and sometimes parenteral nutrition if oral intake is insufficient 1
- Surgical interventions are generally avoided unless absolutely necessary for venting ostomies, and should be performed after extensive local/regional multidisciplinary team (MDT) discussions at hospitals with surgeons and histopathologists experienced in managing these patients 1 Key considerations in managing CIPO include:
- The importance of a multidisciplinary team approach, including gastroenterologists, nutritionists, and pain specialists 1
- The need for individualized treatment plans, taking into account the underlying causes and severity of the condition 1
- The potential benefits of parenteral nutrition (PN) in improving quality of life and reducing morbidity and mortality, particularly in patients with severe chronic small intestinal dysmotility 1 Overall, the management of CIPO requires a comprehensive and individualized approach, prioritizing symptom management, nutritional support, and addressing underlying causes, with the goal of improving quality of life and reducing morbidity and mortality.
From the Research
Definition and Characteristics
- Chronic intestinal pseudo-obstruction (CIP) is a gastrointestinal motility disorder characterized by chronic symptoms and signs of bowel obstruction in the absence of a fixed, lumen-occluding lesion 2.
- CIP is an uncommon condition and can result from primary or secondary causes 2.
- Radiographic findings consist of dilated bowel with air-fluid levels 2.
Diagnosis and Assessment
- The management of CIP involves establishing a correct clinical diagnosis and excluding mechanical obstruction 2.
- Differentiating between idiopathic and secondary forms of CIP is essential 2.
- A symptomatic and physiologic assessment of the parts of the gastrointestinal (GI) tract involved by manometric and whole gut transit scintigraphic studies is necessary 2.
- Careful assessment of nutritional status of the patient is also crucial 2.
Treatment and Management
- Treatment of CIP includes frequent small meals with a low-fat, low-fiber diet, and liquid nutritional supplements may be needed 2.
- Prokinetic agents such as metoclopramide may help to reduce upper GI symptoms 2.
- Trials of drugs such as erythromycin, domperidone, cisapride, and tegaserod may be considered if there is no response 2.
- Subcutaneous octreotide may be helpful to improve small bowel dysmotility, especially in patients with scleroderma 2, 3.
- Nutritional assessment and support is an important aspect of management, with enteral nutrition usually preferred 2.
- In carefully selected patients, feeding jejunostomy with or without decompression gastrostomy may be tried 2.
- Long-term parenteral nutrition should be reserved for patients who cannot tolerate enteral nutrition 2.
Complications and Secondary Causes
- Complications associated with total parenteral nutrition include infections, sepsis, and cholestatic hepatic dysfunction 2.
- CIP can be secondary to connective tissue diseases (CTD) 3.
- CIP can also be caused by other secondary factors, such as drugs, metabolic abnormalities, or infection 4.
- Identifiable causes can be subdivided into those affecting neuronal control of motility and those directly affecting intestinal muscle function 4.