INTESTINAL PSEUDOOBSTRUCTION

Intestinal pseudoobstruction is decreased ability of the intestines to push food through. Generally it also includes dyspepsia, chronic constipation and, in the moments where appear abdominal colic, the clinical and radiological findings are often similar to true intestinal obstruction, but in the absence of a true mechanical obstruction. The disease can begin at any age and it can be a primary condition (idiopathic or inherited) or caused by another disease (secondary).   It can be chronic or acute.

CAUSES

There is some evidence of a genetic association. One form has been associated with DXYS154.  It can occur in conjunction with Kawasaki disease or Parkinson's disease. The term may be used synonymously with Enteric neuropathy if a neurological cause is suspected.

DIAGNOSIS

Attempts must be made to find the underlying cause of intestinal pseudoobstruction. Secondary intestinal pseudoobstruction may be caused by scleroderma (esophageal motility is also impaired), myxedema, amyloidosis, muscular dystrophy, multiple sclerosis, hypokalemia, chronic renal failure, diabetes mellitus, drugs (anticholinergics, opiates)  Primary (idiopathic) intestinal pseudoobstruction diagnosed based on motility studies, x-rays, and gastric emptying studies. It may be caused by problems with the smooth muscle of the intestines (hollow visceral myopathy), or may be caused by problems with the nerves that supply the gut.

TREATMENT

Secondary pseudoobstruction is managed by treating the underlying condition.  There is no cure for primary pseudoobstruction. 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 can be treated with oral supplements, and, rarely, total parenteral nutrition. 

SURGICAL 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 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.

RELATED DISORDERS

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

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