Chronic Intestinal Pseudoobstruction

Current Treatment Options in Gastroenterology
Greg Lyford, Amy Foxx-Orenstein

Abstract

Patients with chronic intestinal pseudoobstruction (CIP) experience a constellation of symptoms including abdominal pain, nausea, fullness, and malaise which fluctuates in severity and invariably result in a diminished quality of life. Though surgical resection or transplantation may be an option for some, there currently is no cure for CIP. Thus, management strategies utilize pharmacologic, intravenous, endoscopic, and surgical techniques to promote transit, minimize painful bloating, reduce complications of stasis, and improve quality of life. Prokinetic agents such as erythromycin, metoclopramide, cisapride, neostigmine, and tegaserod may be effective for acute exacerbations. Octreotide may reduce symptoms of bacterial overgrowth and bloating by stimulating migrating motor complexes. Enteral tubes for venting and nutritional support may reduce hospitalizations. Total parenteral nutrition (TPN), fraught with well-known complications, may be the only tolerated source for nutrients and fluid. Advanced disease may magnify nutritional problems, difficulties of long term intravenous and intestinal access, and poor symptom control. Because the initial process may manifest in other intestinal regions following surgery, resection of ...Continue Reading

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