Pneumatosis Intestinalis: Causes, Symptoms & Treatment

Pneumatosis intestinalis is a very rare condition involving gas retention in the digestive organs. Various causes are discussed. Often, this condition is diagnosed as an incidental finding.

What is pneumatosis intestinalis?

Pneumatosis intestinalis is characterized by gas accumulation in the walls of the digestive tract. In this case, the gas accumulation can occur below the serosa as well as below the mucosa. The serosa represents a smooth outflow of various organs such as pericardium, thoracic cavity or peritoneum. In the case of pneumatosis intestinalis, gas accumulation may occur in the serosa of the peritoneum. The mucosa refers to the mucous membranes. In the course of the disease, gas accumulations sometimes form below the mucosa. Pneumatosis intestinalis is very rare and usually the result of other underlying diseases. In addition, the disease is divided into different subcategories depending on the involvement of a particular digestive organ. When the gas accumulation is located in the colon, the clinical picture is also referred to as pneumatosis coli. Furthermore, the so-called pneumatosis cystoides intestinalis represents a special form of the disease. The term pneumatosis intestinalis was first used by the physicians Lerner and Gazin in 1946. The prognosis of the disease always depends on the underlying disease. The course can be harmless and almost asymptomatic or life-threatening.

Causes

There are many causes of the disease. The most common trigger is infectious colitis, which is further exacerbated by the administration of drugs toxic. Necrotizing enterocolitis can also be a trigger. Furthermore, an undersupply of blood in the context of an intestinal obstruction can also be causative. Even previous endoscopic examinations are sometimes known to trigger the disease. Pneumatosis intestinalis itself is therefore often a symptom of both serious and harmless diseases. In addition to bacterial or drug triggers, mechanical causes also play a role. Thus, a gastric ulcer, a narrowing of the gastric outlet (pyloric stenosis) or duodenal stenosis often also produce gas accumulations in the walls of the digestive organs. Another complex of causes is the weakening of the immune system. This leads to atrophy of the Peyer’s plaques, which results in loss of intestinal wall integrity. Thus, secondary gas accumulation may develop in the intestinal wall. Biochemical, mechanical, or bacterial processes are discussed for pathogenesis. Which of the theories is now correct cannot yet be answered unequivocally.

Symptoms, complaints, and signs

The course of the disease is highly variable and may even be asymptomatic in many patients. However, the disease is often initiated by acute diarrhea, especially if there is a history of bacterial infection. In some cases, hemorrhagic diarrhea also occurs, usually caused by Shiga toxin-producing Escherichia coli. Krohn’s disease or ulcerative colitis can also lead to pneumatosis intestinalis. In pneumatosis cyctoides intestinalis, which is a special form of pneumatosis intestinalis, only the intestine is affected by these gas accumulations. This condition usually occurs secondarily following a serious illness. However, in 15 percent of cases, the disease also occurs primarily without an identifiable cause. Many diseases of the digestive system or even those outside the digestive system can lead to this gas accumulation. However, therapeutic procedures such as endoscopy, chemotherapy, or immunosuppressive treatments can also cause pneumatosis cyctoides intestinalis. Which symptoms can be assigned to pneumatosis intestinalis proper or to a specific underlying disease is often also not clearly identifiable.

Diagnosis and course of the disease

Pneumatosis intestinalis is diagnosed with the aid of imaging techniques. Thus, the pronounced gas accumulations can already be detected by x-rays of the abdomen. However, if flatulence is present that has nothing to do with the gas accumulations in the intestinal walls, a positively false diagnosis may be made. However, with computed tomography, it is possible to clearly distinguish whether the gas accumulation is extramural (outside the walls) or intramural (inside the walls).

Complications

In most cases, complications occur with this disease, as it can only be diagnosed by chance and not at an early stage. In this case, the affected persons suffer from various complaints in the area of the stomach and intestines, which significantly reduce and limit the quality of life of the affected persons. Most patients complain of constant diarrhea, which can also lead to psychological discomfort and even depression. Chron’s disease can also develop and complicate the daily life of the affected person. The gas accumulation leads to severe flatulence and a bloated abdomen. In many cases, those affected feel uncomfortable with the symptoms and also suffer from inferiority complexes or reduced self-esteem. However, the further course of the disease strongly depends on its cause, so that a general prediction is usually not possible. The treatment itself is carried out either with the help of a surgical intervention or the intake of medication. However, this is not always successful. No particular complications occur during the treatment itself. In some cases, however, those affected are dependent on a special diet to avoid these complaints.

When should one go to the doctor?

Pneumatosis intestinalis must always be examined and treated by a medical professional. There is no self-healing with this condition. In most cases, the symptoms worsen and further complications occur if pneumatosis intestinalis is not treated in time. As a rule, a doctor should be consulted if the affected person suffers from diarrhea for a long period of time and without any particular reason. Similarly, there may be severe gas accumulation in the intestine, which can have a very negative impact on the patient’s quality of life. If these symptoms persist for a longer period of time and are not related to food intolerance, a doctor must be consulted. As a rule, pneumatosis intestinalis can be diagnosed by an internist or by a general practitioner. However, the further method of treatment always depends on the exact causes of pneumatosis intestinalis, so that surgical intervention may also be necessary. It cannot be generally predicted whether the disease will result in a reduced life expectancy. Early diagnosis and treatment always have a positive effect on the further course of the disease.

Treatment and therapy

The therapy of pneumatosis intestinalis depends on the underlying disease present in each case. Often, a primary gas accumulation without an identifiable cause does not need to be treated at all. In this case, the disease often progresses without symptoms. If symptoms are present, they are usually caused by the underlying disease. However, if it is diagnostically determined that intramural gas accumulation is present, it should be determined whether another disease is causative and what the disease is. Thus, pneumatosis intestinalis may sometimes even present as the first symptom of an entirely different disease. Besides the toxic infectious, the mechanical or other inflammatory causes, a malignancy can also be causative for pneumatosis intestinalis. It is also important to know exactly which bacteria are present in the case of infection. For example, in infectious toxic courses, standard [[antibiotics]9 cannot be used because they really promote the release of toxins. Inflammatory processes due to autoimmune reactions against the intestine, of course, again require a different treatment strategy. Overall, however, the treatment of pneumatosis intestinalis is rarely the primary focus, but rather the underlying disease.

Prevention

It is not possible to make a specific recommendation for prevention of pneumatosis intestinalis. Intramural gas accumulation usually represents a sequela of an existing underlying disease, the etiology of which differs in each individual case. To reduce the risk of developing a serious health disorder, a healthy lifestyle with a balanced diet, plenty of exercise, and low stress are generally recommended.

Follow-up

Because pneumatosis intestinalis is detected only incidentally in most cases, measures of follow-up are severely limited in most cases.First and foremost, those affected should consult a doctor at a very early stage, especially at the first signs and symptoms of the disease, so that other complications or a further worsening of the symptoms do not occur. An early diagnosis of pneumatosis intestinalis usually always has a very positive effect on the further course of the disease. In most cases, the disease itself does not require treatment, so that no special measures of follow-up care are necessary. If another disease is responsible for the symptoms of pneumatosis intestinalis, this is usually treated with the help of medication. Affected persons should pay attention to a regular intake and to the correct dosage of the medication in order to permanently alleviate the symptoms. When taking antibiotics, it should be noted that they should not be taken together with alcohol. In this regard, regular checks and examinations by a doctor are still necessary to properly monitor the current state of the disease.

What you can do yourself

Because this disease is extremely rare, affected individuals should be screened for other conditions, as they may be the cause of pneumatosis intestinalis. Only when the underlying disease is known can pneumatosis intestinalis be treated and a prognosis made. Very often, the immune defenses of affected patients are weakened. Here the patient can do a lot with a healthy lifestyle to support his recovery. They should eat less fast food and instead eat more fruit and vegetables. A fresh diet rich in minerals and vitamins should be supplemented with plenty of fluids. Water, herbal teas and thin juice spritzers are suitable for this purpose. One and a half to three liters a day are recommended. In addition to a healthy diet, getting enough sleep and abstaining from nicotine and alcohol are also part of effectively supporting the body’s immune system. In some cases, a specific diet should also be followed to curb the symptoms of pneumatosis intestinalis, such as flatulence or a bloated abdomen. Sufferers can seek advice from their physician in this regard, especially if the medications given are not working as desired. Also excretory and detoxifying measures as well as the care of the intestinal culture can support the recovery. Naturopathic physicians or alternative practitioners can make recommendations in this regard.