|Classification and external resources|
Intestinal Pseudo-obstruction is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterised by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen. Clinical features can include abdominal pain, nausea, severe distension, vomiting, dysphagia, diarrhoea and constipation, depending upon the part of the gastrointestinal tract involved. The condition can begin at any age and it can be a primary condition (idiopathic or inherited) or caused by another disease (secondary).
In primary chronic intestinal pseudo-obstruction (the majority of chronic cases), the condition may be caused by an injury to the smooth muscle (myopathic) or the nervous system (neuropathic) of the gastrointestinal tract.
Secondary chronic intestinal pseudo-obstruction can occur as a consequence of a number of other conditions, including Kawasaki disease, Parkinson's disease, Chagas' Disease, Hirschsprung's Disease, Intestinal Hypoganglionosis, collagen vascular diseases, endocrine disorders and use of certain medications. The term may be used synonymously with Enteric neuropathy if a neurological cause is suspected.
Clinical features of intestinal pseudo-obstruction can include abdominal pain, nausea, severe distension, vomiting, dysphagia, diarrhoea and constipation, depending upon the part of the gastrointestinal tract involved. In addition, in the moments in which abdominal colic occurs, abdominal x-ray shows intestinal air fluid level. All of these features are also similar in true mechanical obstruction of the bowel.
Attempts must be made to determine whether there is a secondary cause amenable to treatment.
Primary (idiopathic) intestinal pseudo-obstruction is diagnosed based on motility studies, x-rays and gastric emptying studies.
Secondary chronic intestinal pseudo-obstruction is managed by treating the underlying condition.
There is no cure for primary chronic intestinal pseudo-obstruction. It is important that nutrition and hydration is maintained, and pain relief is given. Drugs that increase the propulsive force of the intestines have been tried, as have different types of surgery.
Prucalopride, Pyridostigmine, Metoclopramide, cisapride, and erythromycin may be used, but they have not been shown to have great efficacy. In such cases, treatment is aimed at managing the complications. Linaclotide is a new drug that has not yet received approval by Food and Drug Administration but in the future looks promising in the treatment of Chronic intestinal pseudo-obstruction, Gastroparesis and Inertia coli.
Intestinal stasis, which may lead to bacterial overgrowth and subsequently, diarrhea or malabsorption is treated with antibiotics.
Nutritional deficiencies are treated by encouraging patients to avoid food high in fat and fibre, which increase abdominal distention and discomfort, and have small, frequent meals (5-6 per day), focusing on liquids and soft food. Reducing intake of poorly absorbed sugar alcohols may be of benefit. Referral to an accredited dietitian is recommended. If dietary changes are unsuccessful in meeting nutritional requirements and stemming weight loss, enteral nutrition is used. Many patients eventually require parenteral nutrition.
Cannabis has long been known to limit or prevent nausea and vomiting from a variety of causes. This has led to extensive investigations that have revealed an important role for cannabinoids and their receptors in the regulation of nausea and emesis. With the discovery of the endocannabinoid system, novel ways to regulate both nausea and vomiting have been discovered that involve the production of endogenous cannabinoids acting centrally. The plant Cannabis has been used in clinic for centuries, and has been known to be beneficial in a variety of gastrointestinal diseases, such as emesis, diarrhea, inflammatory bowel disease and intestinal pain. Moreover, modulation of the endogenous cannabinoid system in gastrointestinal tract may provide a useful therapeutic target for gastrointestinal disorders. While some GI disorders may be controlled by diet and pharmaceutical medications, others are poorly moderated by conventional treatments. Symptoms of GI disorders often include cramping, abdominal pain, inflammation of the lining of the large and/or small intestine, chronic diarrhea, rectal bleeding and weight loss. Patients with these disorders frequently report using cannabis therapeutically.
Surgical and other procedures
Intestinal decompression by colostomy or tube placement in a small stoma can also be used to reduce distension and pressure within the gut. The stoma may be a gastrostomy, enterostomy or cecostomy, and may also be used to feed or flush the intestines.
Colostomy or ileostomy can bypass affected parts if they are distal to (come after) the stoma. For instance, if only the large colon that is affected, an ileostomy may be helpful.
Resection of affected parts may be needed if part of the gut dies (for instance toxic megacolon), or if there is a localised area of dysmotility.
Gastric and colonic pacemakers have been tried. These are strips placed along the colon which create an electric discharge intended to cause the muscle to contract in a controlled manner.
A potential solution, albeit radical, is a multi-organ transplant. The operation involved transplanting the pancreas, stomach, duodenum, small intestine, and liver, and was performed by Doctor Kareem Abu-Elmagd on Gretchen Miller, the subject of the Discovery Channel program Surgery Saved My Life.
- Ogilvie syndrome: acute pseudoobstruction of the colon in severely ill debilitated patients.
- Hirschsprung's disease: enlargement of the colon due to lack of development of autonomic ganglia.
- Intestinal neuronal dysplasia: a disease of motor neurons leading to the bowels.
- Bowel obstruction: mechanical or functional obstruction of the bowel most commonly due to adhesions, hernias or neoplasms.
- Enteric neuropathy: alternative name sometimes used for diagnosis in UK
- Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: A single centre study. Stanghellini, V., Cogliandro, R. F., de Giorgio, R., Barbara, G., Morselli-Labate, A. M., Cogliandro, L, & Corinaldesi, R. Clinical Gastroenterology and Hepatology. 2005 3:449-458
- Advances in our understanding of the pathology of chronic intestinal pseudo-obstruction. de Giorgio, R., Sarnelli, G., Corinaldesi, R., & Stanghellini, V. Gut. 2004 Nov 53(11):1549-52
- Chronic intestinal pseudobstruction. Antonucci A, Fronzoni L, Cogliandro L, Cogliandro RF, Caputo C, De Giorgio R, Pallotti F, Barbara G, Corinaldesi R, Stanghellini V. World J Gastroenterol. 2008 May 21;14(19):2953-61
- Sutton DH, Harrell SP, Wo JM (February 2006). "Diagnosis and management of adult patients with chronic intestinal pseudoobstruction". Nutr Clin Pract 21 (1): 16–22. doi:10.1177/011542650602100116. PMID 16439766.
- Saunders MD (October 2004). "Acute colonic pseudoobstruction". Curr Gastroenterol Rep 6 (5): 410–6. doi:10.1007/s11894-004-0059-5. PMID 15341719.
- Diagnosis, treatment and nutritional management of chronic intestinal pseudo-obstruction. Lacy, B. E., & Loew, B. J. Nutrition Issues in Gastroenterology, Series 77. 2009 Aug:9-24
- Guzé CD, Hyman PE, Payne VJ (January 1999). "Family studies of infantile visceral myopathy: a congenital myopathic pseudo-obstruction syndrome". Am. J. Med. Genet. 82 (2): 114–22. doi:10.1002/(SICI)1096-8628(19990115)82:2<114::AID-AJMG3>3.0.CO;2-H. PMID 9934973.
- Auricchio A, Brancolini V, Casari G, et al. (April 1996). "The locus for a novel syndromic form of neuronal intestinal pseudoobstruction maps to Xq28". Am. J. Hum. Genet. 58 (4): 743–8. PMC 1914695. PMID 8644737.
- Akikusa JD, Laxer RM, Friedman JN (May 2004). "Intestinal pseudoobstruction in Kawasaki disease". Pediatrics 113 (5): e504–6. doi:10.1542/peds.113.5.e504. PMID 15121996.
- Briejer, M. R.; Prins, N. H.; Schuurkes, J. A. (2001). "Effects of the enterokinetic prucalopride (R093877) on colonic motility in fasted dogs". Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society 13 (5): 465–472. doi:10.1046/j.1365-2982.2001.00280.x. PMID 11696108.
- Oustamanolakis, P.; Tack, J. (2012). "Prucalopride for chronic intestinal pseudo-obstruction". Alimentary Pharmacology & Therapeutics 35 (3): 398. doi:10.1111/j.1365-2036.2011.04947.x.
- "Textbook of Gastroenterology" by Tadataka Yamada,Editor John Wiley & Sons, 2011 ISBN 144435941X, 9781444359411
- Sharma S, Ghoshal UC, Bhat G, Choudhuri G (November 2006). "Gastric adenocarcinoma presenting with intestinal pseudoobstruction, successfully treated with octreotide". Indian J Med Sci 60 (11): 467–70. doi:10.4103/0019-5359.27974. PMID 17090868.
- Sørhaug S, Steinshamn SL, Waldum HL (April 2005). "Octreotide treatment for paraneoplastic intestinal pseudo-obstruction complicating SCLC". Lung Cancer 48 (1): 137–40. doi:10.1016/j.lungcan.2004.09.008. PMID 15777981.
- Regulation of nausea and vomiting by cannabinoids and the endocannabinoid system.
- Role of endogenous cannabinoid system in the gut.
- Gastrointestinal Disorders.
- Discovery Channel - Multiorgan transplant