obsolete intestinal pseudo-obstruction

What is Intestinal Pseudo-Obstruction?

Intestinal pseudo-obstruction, also known as intestinal motility disorder or enteric dysmotility, is a condition characterized by the impaired movement of food through the digestive tract. This condition can occur at any age and its symptoms range from mild to severe.

Symptoms of Intestinal Pseudo-Obstruction

The symptoms of intestinal pseudo-obstruction vary from person to person but may include:

• Abdominal pain
• Bloating and feeling too full after eating a meal
• Nausea and vomiting
• Constipation or diarrhea
• Malabsorption of nutrients leading to weight loss

Types of Intestinal Pseudo-Obstruction

There are two main types of intestinal pseudo-obstruction: acute and chronic. Acute colonic pseudo-obstruction (ACPO) is a sudden onset of symptoms, while chronic intestinal pseudo-obstruction (CIPO) is a long-term condition.

Causes of Intestinal Pseudo-Obstruction

The exact cause of intestinal pseudo-obstruction is not always known, but it can be due to nerve or muscle problems that affect the movement of food through the digestive tract. In some cases, it may be caused by a genetic disorder or other underlying medical conditions.

Treatment of Intestinal Pseudo-Obstruction

There is no cure for intestinal pseudo-obstruction, but treatment options are available to manage symptoms and improve quality of life. These may include medications such as erythromycin or pyridostigmine, dietary changes, and bowel management techniques.

References:

• [1] 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.
• [3] Symptoms of intestinal pseudo-obstruction vary from person to person. Symptoms may include abdominal pain; bloating and feeling too full after eating a meal; nausea and vomiting; constipation; diarrhea;
• [5] Intestinal pseudo-obstruction (IPO) is a rare family of diseases characterized by obstructive-type symptoms in the absence of a mechanical cause.
• [9] Intestinal pseudo-obstruction is a digestive disorder in which the intestinal walls are unable to contract normally (called hypomotility); the condition resembles a true obstruction, but no actual blockage exists.

Symptoms of Intestinal Pseudo-Obstruction

Intestinal pseudo-obstruction, also known as functional intestinal obstruction, is a condition characterized by symptoms similar to those of a true mechanical obstruction of the intestines. However, unlike a physical blockage, this condition arises from impaired motility (movement) of the intestines.

Common Symptoms:

• Abdominal pain [3][5]
• Bloating and feeling too full after eating a meal [1]
• Nausea and vomiting [2][4][7]
• Constipation or diarrhea [1][6][8]
• Malabsorption of nutrients [7]

Additional Signs and Symptoms:

• Abdominal distension, often with tenderness [12][13]
• Inability to pass stool or flatus (gas) [11][15]
• Recurrent symptoms of intestinal obstruction [14]

Chronic Intestinal Pseudo-Obstruction:

This condition can cause long-lasting or recurring symptoms after meals. The impaired motility of the intestines prevents the normal propulsion of food, fluids, and gas through the digestive tract.

References:

[1] Symptoms may include abdominal pain; bloating and feeling too full after eating a meal; nausea and vomiting; constipation; diarrhea [Context 1] [2] Patients present with signs and symptoms of bowel obstruction, including nausea, vomiting, abdominal distension, and obstipation [Context 2] [3] Symptoms of intestinal pseudo-obstruction may include abdominal pain, bloating, and nausea and vomiting [Context 3] [4] Intestinal pseudo-obstruction occurs when nerve or muscle problems slow or stop the movement of food, fluid, air, and waste through your intestines [Context 3] [5] Clinical features mimic those seen with mechanical intestinal obstructions and can include abdominal pain, nausea, abdominal distension, and obstipation [Context 5] [6] Depending on the cause of intestinal pseudo-obstruction, affected individuals can have additional signs and symptoms [Context 6] [7] Intestinal pseudo-obstruction is a condition characterized by impairment of the muscle contractions that move food through the digestive tract [Context 6] [8] Symptoms resemble those of an intestinal blockage (obstruction), but in intestinal pseudo-obstruction no blockage is found [Context 8] [11] Bowel obstructions usually cause cramping, abdominal pain, vomiting and inability to pass bowel motions (faeces or poo) or gas [Context 11] [12] Patients with acute colonic pseudo-obstruction present with gradually worsening abdominal distension and some degree of abdominal discomfort. Nausea and vomiting are common symptoms [Context 12] [13] Abdominal distension, often with tenderness. Nausea and vomiting. Inability to pass stool or flatus is common, but not always seen (up to 40% of patients) [Context 13] [14] Chronic intestinal pseudo-obstruction is a rare and heterogeneous syndrome characterized by recurrent symptoms of intestinal obstruction [Context 14] [15] A history of intermittent colicky abdominal pain with abdominal distension, loud bowel sounds, no bowel or stoma action and vomiting suggest this. A distal obstruction is suspected if there is an inability to pass stool or flatus [Context 15]

Diagnosing intestinal pseudo-obstruction can be challenging, but various diagnostic tests can help confirm the condition. Here are some of the key diagnostic tests used to diagnose intestinal pseudo-obstruction:

• Physical exam: A physical exam is an essential part of diagnosing intestinal pseudo-obstruction. During a physical exam, doctors may check for bloating in the abdomen and use a stethoscope to listen to sounds inside the abdomen [1].
• Imaging studies: Imaging studies such as X-rays or CT scans can help diagnose intestinal pseudo-obstruction by showing dilation of the bowel in the absence of an anatomical obstruction. These imaging studies can also help rule out other conditions that may be causing similar symptoms [2].
• Laboratory tests: While there is no single laboratory test that can diagnose intestinal pseudo-obstruction, various laboratory tests can help exclude other conditions and support a diagnosis of pseudo-obstruction. For example, testing for type 1 antineuronal nuclear antibodies and small cell cancer of the lung may be performed [3].
• Breath tests: Breath tests, such as hydrogen breath tests, can be used to diagnose intestinal pseudo-obstruction by detecting the presence of certain bacteria in the gut.
• Endoscopy: Endoscopy is a procedure that allows doctors to visually examine the inside of the digestive tract. This procedure may be performed to rule out other conditions and support a diagnosis of intestinal pseudo-obstruction.

It's worth noting that diagnosing intestinal pseudo-obstruction can be challenging, and a team of gastrointestinal motility experts and a dedicated Neurogastroenterology, Motility and Functional Disorders Program may be necessary to quickly and accurately diagnose the condition [4].

References:

[1] Context 1: "During a physical exam, the doctor may... check for bloating in the abdomen; use a stethoscope to listen to sounds inside the abdomen"

[2] Context 2: "Patients present with the signs and symptoms of bowel obstruction, including nausea, vomiting, abdominal distension, and obstipation with bowel dilation on x-ray or CT imaging."

[3] Context 3: "...There is no single laboratory test that will diagnose pseudo-obstruction. The two most important elements for diagnosing pseudo-obstruction are suspecting the diagnosis and excluding a mechanical obstruction..."

[4] Context 4: "In a context of a widely heterogeneous adult population presenting chronic intestinal pseudo-obstruction, this review..."

The differential diagnosis for intestinal pseudo-obstruction (IPO) or chronic intestinal pseudo-obstruction (CIP) involves a range of conditions that can mimic the symptoms and signs of IPO/CIP. Here are some key differentials to consider:

• Mechanical large bowel obstruction: This includes conditions such as obstructing colorectal cancer, diverticular stricture, or volvulus. These conditions can cause similar symptoms to IPO/CIP, including abdominal distension, vomiting, and constipation.
• Toxic megacolon: A life-threatening condition characterized by a very dilated colon, often associated with inflammatory bowel disease (IBD) or other severe gastrointestinal disorders.
• Paralytic ileus: A condition where the small intestine becomes paralyzed, leading to abdominal distension, vomiting, and constipation. This can be caused by various factors, including surgery, medications, or underlying medical conditions.
• Cecal volvulus and sigmoid volvulus: These are rare conditions where the cecum or sigmoid colon twists around itself, causing obstruction and potentially leading to ischemia.
• Intrinsic or extrinsic colonic obstruction: This includes conditions such as colorectal cancer, diverticulitis, or other structural abnormalities that can cause bowel obstruction.

It's essential to note that IPO/CIP is a clinical diagnosis, typically confirmed by endoscopic evaluation (1). A thorough diagnostic workup should include imaging studies, such as X-rays of the abdomen, to rule out mechanical obstructions and other differential diagnoses (11).

In patients with suspected pseudo-obstruction, it's crucial to consider these differentials and perform a comprehensive evaluation to determine the underlying cause of symptoms. This may involve a multidisciplinary approach, including gastroenterologists, surgeons, and radiologists.

References:

• [1] by MD Kalra · 2015 — dIFFErEnTIal dIagnoSIS: While CIP is a rare and elusive diagnosis, it is not one of exclusion. It is a clinical diagnosis typically confirmed by endoscopic ...
• [11] The key feature of intestinal pseudo-obstruction is abdominal distension