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Chronic Intestinal Pseudo-Obstruction

The following is a fact sheet by the Association of Gastrointestinal Motility Disorders, Inc. (AGMD).

What is chronic intestinal pseudo-obstruction?

Chronic intestinal pseudo-obstruction (CIP) is a disorder of the gastrointestinal tract characterized by symptoms and signs which suggest mechanical obstruction of the intestinal tract, although no obstruction is present.

What are some other related terms for chronic intestinal pseudo-obstruction?

  • Acute colonic ileus
  • Chronic idiopathic intestinal pseudo-obstruction
  • CIP
  • CIIP
  • Colonic pseudo-obstruction
  • Congenital short bowel syndrome
  • Enteric neuromyopathy
  • Enteric neuropathy
  • Hollow visceral myopathy
  • Intestinal pseudoobstruction
  • Mitochondrial neurogastrointestinal encephalopathy
  • Ogilvie's syndrome
  • Pseudoobstructive syndrome

What are the causes?

Chronic intestinal pseudo-obstruction are grouped into 3 categories. Primary (either neuropathic or myopathic in nature); secondary (due to collagen vascular diseases, endocrine disorders, malignancies, neurologic disorders, etc.); or idiopathic (no known cause).

Who does chronic intestinal pseudo-obstruction affect?

It may affect anyone at any age.

What are some of the symptoms?

Symptoms may include severe abdominal pain, constipation and/or diarrhea, feeling of incomplete evacuation, nausea and/or vomiting, abdominal distention (belly swelling), hard belly, early satiety (fullness), esophageal problems, malabsorption, malnutrition, slow stomach emptying (gastroparesis), weight loss/gain, bacterial overgrowth, genitourinary involvement and abnormal bladder function. Some patients may also experience ophthalmoplegia (weakness in the muscles that control eye movement), intellectual disability, seizures. Other symptoms as indicated by patients in an AGMD study included difficulty eating, fear of eating, low back pain, decrease in muscle tone, muscular/joint pain, fatigue, malaise, difficulty concentrating as well as many other unexplained and complex symptoms affecting the entire body, pending on the cause.

How is it diagnosed?

Patient medical history, physical exam, lab studies, x-ray studies, CT scan, barium studies, endoscopic studies, gastric emptying scan, Sitz marker study, manometry studies, full-thickness biopsies of intestinal wall, laparotomy.

Even though it is called pseudo-obstruction, can a patient have a true mechanical obstruction?

A true mechanical obstruction may develop due to scar tissue, adhesions, or malignancy.

What are the treatments for chronic intestinal pseudo-obstruction?

  • Treating patients with chronic intestinal pseudo-obstruction remains a challenge
  • Diet modification and addressing nutritional deficiencies
  • Tube feedings and TPN
  • Decompression of distended intestinal segments via intermittent nasogastric suction, rectal tubes, or endoscopy is helpful for many patients.
  • Prokinetic agents such as erythromycin, cisapride, (not available for routine clinical use, although it can be obtained in very limited circumstances), Metoclopramide (which has a black box warning regarding its side-effects including the possibility of tardive dyskinesia), Domperidone, (not approved in the United States, however, available at compounding pharmacies as well as in Canada and Europe), and Octreotide
  • Antibiotics (for bacterial overgrowth)
  • Antiemetics for nausea
  • Pain control
  • Surgery (intestinal resection)

Is there a cure for chronic intestinal pseudo-obstruction?

Unfortunately, at this time, there is no cure.

The information contained in the fact sheet was written by Maryangela DeGrazia-DiTucci, President/Patient/Founder and reviewed by AGMD Medical Advisors. This information sheet should be used as a guide only and should not serve as a substitute for medical advice. Patients are urged to contact their physician regarding any questions or concerns they may have related to their health.

 

This page was last modified on February 6, 2017

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