Who manages pseudo-obstruction of the gut?

From the Guidelines

Pseudo-obstruction of the gut is typically managed by a multidisciplinary team led by gastroenterologists, with input from surgeons, nutritionists, and pain specialists. The management of this condition requires a comprehensive approach, considering the complex interplay of factors that contribute to its development and progression. According to the study published in Gut in 2020 1, surgery may be considered in adults to help patients with pseudo-obstruction, although the decision to undertake surgery needs to be multidisciplinary and based on each individual patient.

The diagnosis of pseudo-obstruction can be challenging, and a definitive diagnosis should only be given if there is a clear cause identified 1. The clinical features, results of investigations, and histology may not all combine to indicate one specific diagnosis, and other factors such as unrecognised organic small bowel obstruction, drug usage, and psychosocial problems may contribute to the patient's presentation.

Key considerations in the management of pseudo-obstruction include:

• Supportive care, including bowel rest, intravenous fluids, and correction of electrolyte imbalances
• Medications to stimulate gut motility, such as prokinetics
• Pain management, avoiding opioids due to their potential to worsen gut dysmotility
• Nutritional support, which may require enteral feeding or parenteral nutrition
• Decompression techniques to relieve distension
• Surgical interventions, such as venting enterostomy or subtotal colectomy, in refractory cases

The underlying cause of pseudo-obstruction should be identified and treated when possible, as this condition can result from various disorders affecting the enteric nervous system, smooth muscle, or metabolic processes 1. A multidisciplinary team, including a gastroenterologist, gastrointestinal physiologist, gastrointestinal surgeon, pain team, and nutritional support team, is essential for providing comprehensive care to patients with pseudo-obstruction.

From the Research

Management of Pseudo-Obstruction of the Gut

Pseudo-obstruction of the gut is a complex condition that requires careful management. The following are some of the key points to consider:

• The management of pseudo-obstruction of the gut typically involves a multidisciplinary team of healthcare professionals, including gastroenterologists, surgeons, and other specialists 2, 3.
• Conservative management is often the first line of treatment, and may include measures such as bowel rest, nasogastric decompression, and intravenous hydration 4, 5.
• Medications such as neostigmine and pyridostigmine may be used to help stimulate bowel motility and relieve symptoms 2, 6.
• In some cases, surgery may be necessary to relieve obstruction or to remove damaged or diseased portions of the gut 3, 4.
• The use of nasogastric decompression is not always necessary, and may actually be associated with increased complications such as pneumonia and respiratory failure 5.
• The goal of treatment is to restore normal bowel function, relieve symptoms, and prevent complications 3, 4.

Treatment Options

Some of the treatment options for pseudo-obstruction of the gut include:

• Neostigmine infusion, which has been shown to be effective in relieving symptoms and improving outcomes 6.
• Pyridostigmine, which may be used as an alternative to neostigmine 2.
• Prucalopride, which is a newer medication that has shown promise in treating pseudo-obstruction of the gut 2.
• Surgery, which may be necessary in some cases to relieve obstruction or to remove damaged or diseased portions of the gut 3, 4.
• Bowel rest, nasogastric decompression, and intravenous hydration, which may be used as conservative management measures 4, 5.

Important Considerations

Some important considerations in the management of pseudo-obstruction of the gut include:

• Early diagnosis and treatment are critical to preventing complications and improving outcomes 2, 4.
• A multidisciplinary team of healthcare professionals is often necessary to manage the condition effectively 2, 3.
• The use of nasogastric decompression should be carefully considered, as it may be associated with increased complications 5.
• The goal of treatment is to restore normal bowel function, relieve symptoms, and prevent complications 3, 4.