Chronic intestinal pseudo-obstruction: Progress in management?

Abstract

Chronic intestinal pseudo-obstruction (CIPO) is a severe form of gastrointestinal dysmotility (often due to derangement of the innervation/smooth muscle/interstitial cells of Cajal) with recurrent episodes of intestinal subocclusion mimicking a mechanical obstruction. Because of its complexity and heterogeneity, CIPO is often misdiagnosed or remains unrecognized until advanced stages. Management is a critical aspect in CIPO patient care. So far, most prokinetic drugs have not proven efficacy in restoring intestinal propulsion, thus nutritional support, fluid/electrolyte replacement, and antibiotics are the mainstay of treatment. In this issue of the journal, Ohkubo et al showed promising data indicating that percutaneous endoscopic gastro-jejunostomy (PEG-J) can be proposed as a measure for intestinal decompression, thereby improving CIPO-associated abdominal symptoms, including pain. In addition to a concise update of clinical and diagnostic features, the present minireview tackles management options, with a major emphasis on PEG-J, for CIPO patients.

Abbreviated abstract: Chronic intestinal pseudo-obstruction (CIPO) is one of the most severe forms of gastrointestinal dysmotility with many debilitating and potentially life-threatening symptoms / manifestations. Since most drugs failed to restore gastrointestinal coordinated motility, nutritional support, fluid / electrolyte replacement and antibiotics are still mandatory as life-saving measures. Promising data indicate that percutaneous endoscopic gastro-jejunostomy (PEG-J) can be proposed as a measure for intestinal decompression in CIPO, thereby improving symptoms and preventing malnutrition.

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