Chronic Intestinal Pseudo-Obstruction

Chronic intestinal pseudo-obstruction

Definition: Heterogenous group of disorders characterized by disordered peristalsis leading to intestinal malabsorption and pseudo-obstructive crisis.  Some types are acute.

Radiograph showing marked small bowel dilatation without evidence of an abrupt transition point or mechanically obstructing lesion.

Young girl with chronic intestinal pseudo-obstruction suffering from malnutrition.  There is an ostomy visible.  The gastrostomy tube appears to be draining bilious content.

• There’s no specific diet.  Maximize oral intake as tolerated with small frequent meals. 
• If oral intake is inadequate, enteral tube feeds should be tried.
• Parenteral nutrition should not be delayed in malnutrition when oral/enteral nutrition is inadequate.
• Antroduodenal manometry should be performed in patients who cannot tolerate enteral tube feeds in order to confirm the diagnosis of chronic intestinal pseudo-obstruction.
• Home parenteral nutrition is indicated for patients with confirmed motility disorders who have failed attempts to tolerate enteral tube feeding advancements.
• Regardless of antroduodenal manometry testing or history of intolerance, patients should be challenged as tolerated to advance their oral/enteral feeds as conditions can change over time.
• Patients with gastrointestinal motility dysfunction may benefit from prokinetic medications:
  • Erythromycin
  • Cisapride
  • Metoclopramide
  • Domperidone
  • Octreotide
• Patients with gastrointestinal motility dysfunction may experience malabsorption due to small bowel bacterial overgrowth, which is treatable.