According to abbreviationfinder, the chronic intestinal pseudo-obstruction is preceded by a relapsing disorder of Darmmotalität who frequently intestinal surgery or an acute intestinal pseudo-obstruction of the bowel. Symptoms range from diarrhea to constipation to colicky pain. A causal therapy is usually not available.
What is chronic intestinal pseudo-obstruction?
The medical professional uses the term pseudo-obstruction or intestinal pseudo-obstruction to describe a distended and functionally motionless intestine. The clinical picture was described by H. Ogilvie in the middle of the 20th century and is also called Ogilvie syndrome in his honor. The rare and extremely serious phenomenon mainly affects elderly people who have severe bowel disease or who have undergone bowel surgery.
If the intestinal obstruction has persisted for a long period of time, regardless of surgery, severe bowel disease, or an obstruction of the bowel, it is referred to as chronic intestinal pseudo-obstruction. The CIPO of the bowel is characterized by severe and recurring dysmotility of bowel movement associated with obstruction of the intestinal lumen.
A healthy intestine has precisely coordinated and permanent peristalsis, which is used for the movement of intestinal contents, digestion and cleaning. The chronic intestinal pseudo-obstruction can accordingly severely impair the function of the intestine.
There are various possible causes for a CIPO. The cessation of bowel movement is either muscular or neurogenic. The disease occurs either primarily idiopathically through a familial disposition or on the basis of a secondary genesis. Various diseases can form the larger framework of chronic intestinal pseudo-obstruction. Often those affected are patients with diabetic autonomic neuropathy.
The intestinal motility disorder is neurogenic in this case. A progressive systemic scleroderma comes as a primary disease in question. The same is true for muscular myopathies. In individual cases, Ogilvie syndrome can become chronic. If the CIPO was preceded by an IPO, the primary cause is usually a dysfunction in the autonomic nervous system that increases sympathetic activity.
Even trauma or internal medical reason diseases such as bronchitis but can the framework for an intestinal pseudo-obstruction, which basically brings the complication risk of chronicity to CIPO with it.
Symptoms, ailments & signs
The clinical picture of a patient with CIPO depends on the primary disease. The location and size of the disturbed intestinal area also determined the symptoms in individual cases. The same applies to the severity of the movement disorder. The most common symptoms are chronic constipation and diarrhea. The medical professional understands chronic constipation as persistent constipation.
In addition to these basic symptoms, chronic intestinal pseudo-obstruction can also express itself as acute symptoms and thus be accompanied by severe nausea and vomiting. With CIPO, a lot of intestinal gas can accumulate in the intestine pathologically. This phenomenon is also known as meteorism. Often the patients also suffer from colic-like abdominal pain.
If left untreated, the CIPO can lead to various complications. After a certain time, the chronic pseudo-obstruction can, for example, cause ischemic intestinal wall necrosis. This complication is preceded by vascular compression, which can trigger peritonitis. A rupture of the intestinal wall or an elevated diaphragm with impaired breathing can also develop from a chronic intestinal pseudo-obstruction.
Diagnosis is easy in chronic intestinal pseudo-obstruction. The X-ray image in particular shows a characteristic image. Usually the large intestine is enlarged and filled with air. The ascending part of the large intestine can reach a width of over ten centimeters in the X-ray image. For diagnosis, the patient’s abdomen is first X-rayed while standing. In addition to a colon contrast enema, a colonoscopy and computed tomography are then performed.
As differential diagnoses, the doctor must consider constipation and phenomena such as mechanical ileus (intestinal obstruction), the toxic megacolon or the sigmoid volvulus. In its natural course, the CIPO has a rather unfavorable prognosis. Parenteral nutrition is often required after around five years. The therapeutic success often turns out to be unsatisfactory in the long term.
With chronic intestinal pseudo-obstruction, the patient mainly suffers from complaints in the area of the intestine and stomach. These complaints and complications depend on the previous operation, and no general prediction can be made. Most often it is severe pain in the intestines and stomach, as well as vomiting and nausea.
It is not uncommon for diarrhea to occur. An increased amount of gas accumulates in the intestine, which leads to flatulence. As a rule, it is no longer possible for the patient to exercise physical strain, as this is also associated with pain. This can even lead to a rupture of the intestine.
A breathing disorder develops that can lead to panic attacks in many people. Treatment is primarily carried out with the help of medication and a change in diet. It is not uncommon for acute attacks to be treated surgically, whereby the affected person receives an artificial anus.
In most cases, however, the disease progresses positively without complications. As a rule, life expectancy is not affected. After the treatment, the patient can go back to their normal everyday life.
When should you go to the doctor?
In the case of recurring intestinal complaints such as diarrhea, constipation or nausea and vomiting, a serious illness is suspected. A doctor should clarify as early as possible whether the condition is chronic intestinal pseudo-obstruction. Then, as a rule, inpatient treatment is arranged. Patients who already suffer from bowel disease or diabetic autonomic neuropathy often also develop CIPO. There is also an increased risk of chronic intestinal pseudo-obstruction after trauma caused by intestinal surgery or bronchitis.
Anyone suffering from one of these diseases should speak to their doctor if they have unusual symptoms. In the event of severe complications such as breathing disorders, elevated diaphragm or intestinal wall rupture, the emergency services must be alerted. It is best to go to the nearest hospital at the first signs of these symptoms. Medical treatment is generally required at a CIPO. Since the disease can recur, the sick person must be closely monitored even after the initial treatment.
Treatment & Therapy
Therapy for chronic intestinal pseudo-obstruction depends on the primary cause and the general severity of the phenomenon. As a conservative measure, in addition to diet changes, various medications are available as an option. In addition to the administration of laxatives, the administration of prokinetics such as metoclopramide is one of the most common conservative measures. Acetylcholinesterase inhibitors such as neostigmine and pyridostigmine are also a possibility.
The drug administration is a purely symptomatic therapy and cannot be described as a causal treatment method. Also for the symptomatic treatment including intravenous fluid resuscitation and invasive procedures such as parenteral nutrition, or the establishment of a colonic decompression tube or other feeding tubes for vomiting in acute cases. In acute treatment, decompressions through a colonoscopy or surgical measures to relocate an artificial intestinal outlet at the caecum can also be used.
In less severe cases, an intestinal tube in combination with enemas often provides the solution. Surgical interventions for the complete resection of certain sections of the intestine or for the realization of an enterostoma are only indicated in severe cases. The doctor must carefully weigh up the benefits and risks in each individual case in order to be able to provide a targeted therapy proposal.
In the case of certain primary diseases, the cause of the CIPO can be eliminated through medical intervention. Nevertheless, causal therapeutic success for chronic intestinal pseudo-obstruction is rather rare.
Outlook & forecast
The prognosis for chronic intestinal pseudo-obstruction is described as unfavorable. Despite various efforts and times of recovery, the course of the disease cannot be changed or stopped permanently. In many patients, parantal nutrition has to be started after a few years of the first manifestation.
There is no known prospect of a cure for this disease. Patients repeatedly experience recurrent phases in which they draw new hope for a lasting recovery. These episodes are characterized by a complete freedom from symptoms.
It is particularly noteworthy that even doctors cannot detect any obstruction on x-rays or surgical interventions during these phases. Medical intervention or prevention is prevented because of the lack of symptoms, warnings, or minimal signs. Nevertheless, in the further course there is a renewed deterioration in health.
The chronic intestinal pseudo-obstruction is often not recognized or only recognized very late. This represents a potential danger to the patient’s life. The course of the disease increases the likelihood of further diseases occurring. Dealing with the disease triggers an increased experience of stress. Psychosomatic illnesses or mental disorders can develop. These lead to a further deterioration in health, since they also occur in times of symptom-free chronic intestinal pseudo-obstruction.
The chronic intestinal pseudo-obstruction can be prevented to a certain extent. For example, those who suffer from intestinal pseudo-obstruction and seek medical advice in good time reduce the risk of chronification. The preventive measures for pseudo-obstruction in the context of other diseases correspond to the preventive measures for the respective primary disease.
In most cases, those affected have only a few measures and options for direct follow-up care available. The person concerned must first and foremost have an early diagnosis carried out so that there is no further worsening of the symptoms or other complications from this disease. The earlier a doctor is consulted for this disease, the better the further course is usually also.
In most cases, this disease is treated by taking various drugs. The person concerned should always pay attention to the correct dosage and also to a regular intake in order to permanently alleviate the symptoms. Regular controls and examinations of the stomach and intestines are also very important in order to detect tumors and other complaints at an early stage and then treat them.
Since this illness can also lead to severe psychological upset or depression, intensive and loving conversations with your own family or friends are very important, whereby the support of your own family can also have a positive effect on the course of the illness. In many cases it is also worth making contact with other sufferers of the disease.
You can do that yourself
Even if the chronic intestinal pseudo-obstruction at an early stage usually resembles a simple digestive disorder, those affected should by no means downplay the disease. Pure self-treatment is strongly discouraged. Instead, a doctor should be consulted promptly if symptoms occur. If the chronic intestinal pseudo-obstruction is not adequately treated, it can not only lead to severe pain, but in the worst case also to a life-threatening rupture of the intestine.
In consultation with the attending physician, self-help measures can also be taken to alleviate some of the symptoms. Chronic constipation is often preceded by severe diarrhea. In naturopathy, patients are usually recommended to change their diet that is aimed at improving intestinal health and general well-being. We recommend avoiding fatty dishes, meat and sausage products, white flour and sugar, especially in the refined form. Instead, those affected are advised to consume whole grain products as well as plenty of fruit, vegetables and salads.
An intestinal rehabilitation is often advised. The change in diet is then preceded by a thorough colon cleansing using certain laxative salts or enemas. Strains of beneficial intestinal bacteria are ingested to help rebuild healthy intestinal flora. Corresponding preparations are usually offered as gastric juice-resistant capsules.
Appropriate measures should only be considered after consulting the attending physician.