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Decoding intestinal motility: What causes intestinal pseudo-obstruction?
Intestinal pseudo-obstruction (IPO) is a clinical syndrome resulting from severe impairment of the intestinal tract's ability to push food. Although no actual mechanical obstruction occurs, symptoms similar to intestinal obstruction occur, including abdominal pain, nausea, bloating, vomiting, dysphagia, and constipation, depending on the part of the digestive tract affected. Diagnosis of this disease is difficult, often requiring exclusion of other causes of mechanical obstruction, and many patients are often diagnosed late in the course of the disease, making it difficult to accurately assess mortality.
Many patients are diagnosed late in the course of the disease, making the situation even more complicated.
According to a retrospective study, the mortality rate of chronic intestinal pseudo-obstruction (CIPO) is estimated to be between 10% and 25%, varying accordingly depending on the cause. When symptoms last less than six months, acute intestinal pseudo-obstruction or Ogilvie syndrome is diagnosed. If it exceeds this time, it is considered a chronic case.
Clinical manifestations
Clinical features of intestinal pseudo-obstruction include abdominal pain, nausea, bloating, vomiting, dysphagia, and constipation. The occurrence of these symptoms depends not only on the part of the digestive tract involved, but also on how long the symptoms last. Symptoms may come on and off and may last for a long time. Due to the non-specific nature of symptoms, patients not uncommonly require multiple visits to the doctor.
Symptoms may vary depending on whether the disease is primary or secondary, and management may change accordingly.
Cause analysis
In most cases of chronic intestinal pseudo-obstruction, primary CIPO results from the loss of the intestinal tract's own propulsive ability. These causes can be divided into three categories: myopathies (affecting smooth muscle), interstitial diseases (affecting Creutzfeldt-Jakob cells), and neuropathies (affecting the nervous system of the digestive tract). Some cases appear to be genetically linked. In addition, intestinal pseudo-obstruction can be caused by many other diseases, such as:
- Hirschsprung disease: loss of nerve cells in the colon.
- Chagas disease: Chronic parasitic infection leading to loss of nerve fibers in the colon.
- Parkinson's disease: related to neurodegeneration of the digestive tract.
- Autoimmune diseases: such as systemic lupus erythematosus and scleroderma leading to collagen vascular deposition and intestinal motility disorders.
Diagnostic methods
The symptoms of intestinal pseudo-obstruction are very nonspecific, so the diagnostic process often requires excluding the possibility of other mechanical obstructions. Possible diagnostic tasks include:
- Gastric motility study
- Imaging examination: X-ray, CT scan, enema, etc.
- Blood test
- Endoscopy
- Pressure measurement check
Treatment Plan
The goals of treatment for intestinal pseudo-obstruction are primarily to eliminate the cause and manage complications. This includes pain management, improving digestive symptoms, nutritional supplementation and regulating fluid status. When chronic intestinal pseudo-obstruction is caused by another disease, treatment focuses on management of the underlying disease.
If the patient's dietary modifications do not meet the required nutritional needs, enteral nutrition or complete intravenous nutrition is used.
Some medications, such as Prucalopride and pyridostigmine, are designed to promote intestinal motility, while antibiotics are used to treat possible bacterial overgrowth. For severe intestinal pseudo-obstruction, surgery or other interventional methods such as intestinal decompression and ostomy are sometimes necessary.
Potential treatments
To alleviate symptoms, researchers are exploring other potential treatments. These include stem cell transplants and fecal microbiota transplants, among others. However, there have been no studies on the effects of cannabis in intestinal pseudo-obstruction, and predictions of its efficacy remain speculative.
Related diseases
When understanding intestinal pseudo-obstruction, related diseases should also be considered, such as: Ogilvie syndrome, Hirschsprung disease, intestinal neurodevelopmental dysplasia, etc. These diseases are closely related to disorders of intestinal function.
As research into intestinal motility disorders deepens, can more effective treatments be found to improve patients' quality of life?
