Intestinal pseudo-obstruction

Intestinal pseudo-obstruction
Pronunciation
  • soo·doe/uhb·struhk·shn
SpecialtyGastroenterology
SymptomsAbdominal pain, nausea, distention, vomiting, dysphagia, and constipation
ComplicationsIntestinal failure, malabsorption, nutrient deficiencies, small intestinal bacterial overgrowth
DurationVaries according to etiology of disease. < 6 months is considered acute
CausesIdiopathic, Kawasaki disease, Parkinson's disease, Chagas disease, Hirschsprung's disease, intestinal hypogangliosis, collagen vascular disease, mitochondrial disease, endocrine disorders, medication side effects
Diagnostic methodSigns and symptoms consistent with a mechanical intestinal obstruction with no identifying lesion.
Differential diagnosisIntestinal obstruction, Crohn's disease, ovarian torsion, ovarian cyst, neoplasm, infection (parasitic)
TreatmentAimed at management of complications (e.g. nutrition, hydration, pain relief).
Prognosis10–25% mortality rate in chronic cases
FrequencyUnknown

Intestinal pseudo-obstruction (IPO) is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen.[1] Clinical features mimic those seen with mechanical intestinal obstructions and can include abdominal pain, nausea, abdominal distension, vomiting, dysphagia and constipation[2][3] depending upon the part of the gastrointestinal tract involved.

It is a difficult condition to diagnose, requiring exclusion of any other mechanical cause of obstruction.[4] Many patients are diagnosed late in the course of disease after additional symptoms are seen. Mortality is also difficult to accurately determine. One retrospective study estimated mortality to be between 10 and 25% for chronic intestinal pseudo-obstruction (CIPO) and to vary greatly depending on the etiology of the condition.[5] When present for less than six months, it is diagnosed as acute IPO[6] or Ogilvie syndrome.[4] Longer than this is considered chronic.[7] Owing to the difficulty of diagnosis, few studies are available which have attempted to estimate its prevalence.[8]

The condition can begin at any age. Most studies describing CIPO are in pediatric populations.[9][10][4] It can be a primary condition (idiopathic or inherited) or caused by another disease (secondary).[11] It can be a result of myriad of etiologies including infectious, parasitic, autoimmune, genetic, congenital, neurologic, toxic, endocrinological, or anatomical pathology.

Treatment targets nutritional support, improving intestinal motility, and minimizing surgical intervention.[4] Bacterial overgrowth of the small intestine can occur in chronic cases – presenting as malabsorption, diarrhea, and nutrient deficiencies[12] – which may require the use of antibiotics.

  1. ^ Stanghellini V, Cogliandro RF, De Giorgio R, et al. (May 2005). "Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study". Clinical Gastroenterology and Hepatology. 3 (5): 449–58. doi:10.1016/S1542-3565(04)00675-5. PMID 15880314. S2CID 32605317.
  2. ^ De Giorgio R, Sarnelli G, Corinaldesi R, Stanghellini V (November 2004). "Advances in our understanding of the pathology of chronic intestinal pseudo-obstruction". Gut. 53 (11): 1549–52. doi:10.1136/gut.2004.043968. PMC 1774265. PMID 15479666.
  3. ^ Robbins basic pathology. Vinay Kumar, Abul K. Abbas, Jon C. Aster, James A. Perkins (10th ed.). Philadelphia, Pa.: Elsevier. 2018. pp. Chapter 5: intestinal obstruction. ISBN 978-0-323-39413-0. OCLC 972900144.{{cite book}}: CS1 maint: others (link)
  4. ^ a b c d El-Chammas, Khalil; Sood, Manu R. (March 2018). "Chronic Intestinal Pseudo-obstruction". Clinics in Colon and Rectal Surgery. 31 (2): 99–107. doi:10.1055/s-0037-1609024. ISSN 1531-0043. PMC 5825855. PMID 29487492.
  5. ^ Ko, Dayoung; Yang, Hee-Beom; Youn, Joong; Kim, Hyun-Young (2021-05-28). "Clinical Outcomes of Pediatric Chronic Intestinal Pseudo-Obstruction". Journal of Clinical Medicine. 10 (11): 2376. doi:10.3390/jcm10112376. ISSN 2077-0383. PMC 8198288. PMID 34071279.
  6. ^ Saunders MD (October 2004). "Acute colonic pseudoobstruction". Current Gastroenterology Reports. 6 (5): 410–6. doi:10.1007/s11894-004-0059-5. PMID 15341719. S2CID 27281556.
  7. ^ Sutton DH, Harrell SP, Wo JM (February 2006). "Diagnosis and management of adult patients with chronic intestinal pseudoobstruction". Nutrition in Clinical Practice. 21 (1): 16–22. doi:10.1177/011542650602100116. PMID 16439766.
  8. ^ Iida, Hiroshi; Ohkubo, Hidenori; Inamori, Masahiko; Nakajima, Atsushi; Sato, Hajime (2013). "Epidemiology and clinical experience of chronic intestinal pseudo-obstruction in Japan: a nationwide epidemiologic survey". Journal of Epidemiology. 23 (4): 288–294. doi:10.2188/jea.je20120173. ISSN 1349-9092. PMC 3709546. PMID 23831693.
  9. ^ Zenzeri, Letizia; Tambucci, Renato; Quitadamo, Paolo; Giorgio, Valentina; De Giorgio, Roberto; Di Nardo, Giovanni (May 2020). "Update on chronic intestinal pseudo-obstruction". Current Opinion in Gastroenterology. 36 (3): 230–237. doi:10.1097/MOG.0000000000000630. ISSN 1531-7056. PMID 32073506. S2CID 211193582.
  10. ^ Downes, Thomas J.; Cheruvu, Manikandar S.; Karunaratne, Tennekoon B.; De Giorgio, Roberto; Farmer, Adam D. (July 2018). "Pathophysiology, Diagnosis, and Management of Chronic Intestinal Pseudo-Obstruction". Journal of Clinical Gastroenterology. 52 (6): 477–489. doi:10.1097/MCG.0000000000001047. ISSN 1539-2031. PMID 29877952. S2CID 46960493.
  11. ^ Antonucci A, Fronzoni L, Cogliandro L, et al. (May 2008). "Chronic intestinal pseudo-obstruction". World Journal of Gastroenterology. 14 (19): 2953–61. doi:10.3748/wjg.14.2953. PMC 2712158. PMID 18494042.
  12. ^ Cucchiara, Salvatore; Borrelli, Osvaldo (April 2009). "Nutritional challenge in pseudo-obstruction: the bridge between motility and nutrition". Journal of Pediatric Gastroenterology and Nutrition. 48 (Suppl 2): S83–85. doi:10.1097/MPG.0b013e3181a15bfe. hdl:11573/406753. ISSN 1536-4801. PMID 19300134. S2CID 11393186.