Chronic intestinal pseudoobstruction is a recurrent disorder of intestinal motility that is often preceded by bowel surgery or acute intestinal pseudoobstruction. Symptoms range from diarrhea to constipation to colicky pain. Causal therapy is usually not available.
What is chronic intestinal pseudoobstruction?
The medical profession uses the term pseudoobstruction or intestinal pseudoobstruction to describe a distended and functionally motionless bowel. The clinical picture was described by H. Ogilvie in the mid-20th century and is also called Ogilvie’s syndrome in his honor. This rare and extremely serious phenomenon predominantly affects elderly people suffering from severe intestinal diseases or who have undergone intestinal surgery. When intestinal obstruction is present for a prolonged period of time independent of surgery, severe bowel disease, or intestinal obstruction, it is referred to as chronic intestinal pseudo-obstruction. CIPO of the intestine is characterized by severe and recurrent motility disorders of intestinal motility associated with obstruction of the intestinal lumen. A healthy intestine has finely tuned and permanent peristalsis that serves to move intestinal contents, digest and cleanse. Accordingly, chronic intestinal pseudoobstruction can severely impair intestinal function.
Causes
There are several possible contexts for the cause of CIPO. The cessation of bowel movement has either muscular or neurogenic causes. The disease occurs either primarily idiopathic due to familial predisposition or on the basis of secondary genesis. Several conditions may form the larger framework of chronic intestinal pseudoobstruction. Frequently, affected individuals are patients with diabetic autonomic neuropathy. In this case, the intestinal motility disorder is neurogenic. Progressive systemic scleroderma may also be a primary disease. The same applies to muscular myopathies. In isolated cases, Ogilvie syndrome may undergo chronicity. If CIPO is preceded by IPO, the primary cause is usually a dysfunction in the autonomic nervous system that increases sympathetic activity. However, trauma or underlying internal diseases such as bronchitis can also set the stage for intestinal pseudo-obstruction, which basically carries the risk of complications of chronicity to CIPO.
Symptoms, complaints, and signs
The clinical presentation of a patient with CIPO depends on the primary disease. The location and size of the disturbed intestinal area also determined the symptomatology in individual cases. The same applies to the severity of the movement disorder. The most common symptoms are chronic constipation and diarrhea. Chronic constipation is understood by physicians as persistent constipation of the stool. In addition to these basic symptoms, chronic intestinal pseudoobstruction can just as easily manifest itself in acute symptoms and thus be accompanied by severe nausea and vomiting. A pathological amount of intestinal gas may accumulate in the intestine in CIPO. This phenomenon is also known as meteorism. Patients often also suffer from colic-like abdominal pain. If left untreated, CIPO can lead to various complications. After a certain period of time, chronic pseudo-obstruction can cause ischemic necrosis of the intestinal wall. This complication is preceded by vascular compression, which can cause transit peritonitis. Intestinal wall herniation or diaphragmatic herniation with respiratory compromise may also develop from chronic intestinal pseudoobstruction.
Diagnosis
Diagnosis is straightforward in chronic intestinal pseudoobstruction. Specifically, the radiograph shows a characteristic picture. In most cases, the colon is widened and filled with air. The ascending part of the colon can reach a width of more than ten centimeters in the x-ray image. The patient’s abdomen is first x-rayed in the standing position for diagnostic purposes. In addition to a colonic contrast enema, a colonoscopy and a computer tomography are then performed. As differential diagnoses, the physician must consider constipation and phenomena such as mechanical ileus (intestinal obstruction), toxic megacolon, or sigmoid volvulus. In its natural course, CIPO is considered to have a rather unfavorable prognosis.Often, parenteral nutrition becomes necessary after about five years. Therapeutic success often proves unsatisfactory in the long term.
Complications
In chronic intestinal pseudoobstruction, the patient mainly suffers from discomfort in the intestinal and gastric regions. However, these complaints and complications depend on the preceding surgery, and no general prediction can be made. Most often, they are severe pain in the area of the intestine and stomach, as well as vomiting and nausea. It is not uncommon for diarrhea to occur as well. An increased amount of gas accumulates in the intestines, which leads to flatulence. It is usually no longer possible for the patient to perform physical activities, as these are also associated with pain. This can even lead to intestinal perforation. In this case, a breathing disorder develops, which can lead to panic attacks in many people. Treatment is primarily with the help of medication and a change in diet. It is not uncommon for acute attacks to require surgical treatment, in which the affected person is given an artificial bowel outlet. In most cases, however, the disease progresses positively without complications. Life expectancy is usually not affected. After treatment, the patient can resume a normal daily routine.
When should one go to the doctor?
Recurrent intestinal symptoms such as diarrhea, constipation, or nausea and vomiting raise suspicion of a serious illness. A doctor should determine at the earliest opportunity whether the condition is chronic intestinal pseudoobstruction. Subsequently, inpatient treatment is usually arranged. Patients who already suffer from intestinal disease or diabetic autonomic neuropathy often also develop CIPO. There is also an increased risk of developing chronic intestinal pseudoobstruction after trauma from bowel surgery or after bronchitis. Anyone suffering from any of these conditions should speak with the appropriate physician if they experience any unusual symptoms. In case of severe complications such as respiratory problems, diaphragmatic herniation or intestinal wall herniation, the emergency medical services must be alerted. It is best to go to the nearest hospital at the first sign of these symptoms. Medical treatment is always required for CIPO. Because the condition can recur repeatedly, the sufferer must be closely monitored even after initial treatment.
Treatment and therapy
Treatment of chronic intestinal pseudoobstruction depends on the primary cause and the overall severity of the phenomenon. Conservative measures include dietary changes and various drug administration options. In addition to laxative administration, the administration of prokinetics such as metoclopramide is among the most common conservative measures. Acetylcholinesterase inhibitors such as neostigmine and pyridostigmine are also an option. Medication administration is purely symptomatic therapy and cannot be considered a causal treatment method. Also included in symptomatic therapy are intravenous fluid administration and invasive measures such as parenteral nutrition or placement of a colonic decompression tube or other gastric tubes for vomiting in acute cases. Acute treatment may also include decompression by colonoscopy or surgical measures to create an artificial bowel outlet at the caecum. In less severe cases, an intestinal tube in combination with enemas often provides the solution. Surgical interventions for the complete resection of certain intestinal segments or for the realization of an enterostoma are only indicated in severe cases. The physician must weigh the benefits and risks conscientiously in each individual case in order to be able to provide a goal-oriented therapy suggestion. In certain primary diseases, the cause of CIPO can be eliminated by medical intervention. Nevertheless, causal therapeutic success for chronic intestinal pseudoobstruction is rare.
Outlook and prognosis
The prognosis of chronic intestinal pseudoobstruction is described as unfavorable. The course of the disease cannot be changed or permanently stopped despite various efforts and periods of recovery. In many patients, parantal nutrition must be started after a few years of initial manifestation. There is no known prospect of a cure for this disease.Patients repeatedly experience recurrent episodes in which they gain new hope for a sustained recovery. These episodes are characterized by complete freedom from symptoms. It is particularly noteworthy that even physicians are unable to detect any obstruction during radiographs or surgical procedures during these phases. Medical intervention or prevention is prevented due to the lack of symptoms, warnings, or minimal signs. Nevertheless, renewed deterioration occurs as the disease progresses. Chronic intestinal pseudoobstruction is often not recognized or is recognized very late. This poses a potential threat to the patient’s life. The course of the disease increases the likelihood of further illness. Dealing with the disease triggers an increased stress experience. Psychosomatic diseases or psychological disorders may develop. These lead to further deterioration of health, as they occur even during periods of freedom from symptoms of chronic intestinal pseudo-obstruction.
Prevention
Chronic intestinal pseudoobstruction can be prevented to some extent. For example, those who develop intestinal pseudoobstruction and seek timely medical advice reduce the risk of chronicity. The preventive measures of pseudoobstruction in the context of other diseases correspond to the preventive measures for the respective primary disease.
Follow-up
In most cases, only a few measures and options for direct aftercare are available to the affected person in this disease. In this regard, the affected person must first and foremost have an early diagnosis performed so that there is no further worsening of symptoms or other complications from this disease. The earlier a doctor is consulted for this disease, the better the further course is usually. In most cases, the treatment of this disease is done by taking various medications. The affected person should always pay attention to a correct dosage and also to a regular intake in order to alleviate the complaints permanently. Regular checks 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 disease can also cause severe psychological upsets or depression, intensive and loving conversations with one’s own family or friends are very important, whereby the support of one’s own family can also have a positive effect on the course of the disease. In many cases, it is also worthwhile to make contact with other people affected by the disease.
What you can do yourself
Even though chronic intestinal pseudoobstruction at an early stage usually resembles a simple digestive disorder, those affected should by no means play down the disease. Pure self-treatment is strongly discouraged. Instead, a doctor should be consulted promptly when symptoms appear. If chronic intestinal pseudo-obstruction is not treated adequately, it can lead not only to severe pain but also, in the worst case, to a life-threatening intestinal rupture. In consultation with the treating physician, however, self-help measures can be taken to alleviate some of the symptoms. Chronic constipation is often preceded by severe diarrhea. In naturopathy, patients are usually recommended a change in diet aimed at improving intestinal health and general well-being. The renunciation of greasy meals, meat and sausage products, white flour as well as sugar, in particular in the refined form, is recommended. Instead, sufferers are advised to eat whole grain products and plenty of fruit, vegetables and salads. Often also an intestine reorganization is advised. The change in diet is then preceded by a thorough bowel cleansing using certain laxative salts or enemas. To support the rebuilding of a healthy intestinal flora, strains of beneficial intestinal bacteria are taken. Corresponding preparations are usually offered as enteric-coated capsules. However, corresponding measures should only be considered after consultation with the attending physician.
