Chronic intestinal pseudo-obstruction

The chronic intestinal pseudo-obstruction is a recurrent disorder of intestinal totality, often preceded by intestinal operations or an acute intestinal pseudo-obstruction of the intestine. Symptoms range from diarrhea to constipation to colicky pain. A causal therapy is usually not available.

What is chronic intestinal pseudo-obstruction?

With the concept of Pseudo-obstruction or intestinal pseudo-obstruction the doctor describes a distended and functionally motionless intestine. The clinical picture was described in the middle of the 20th century by H. Ogilvie and is also in his honor Ogilvie syndrome called. The rare and extremely serious phenomenon mainly affects elderly people who suffer from severe bowel disease or have had bowel surgery.

If the intestinal obstruction has been present for a long period of time, regardless of surgery, severe bowel disease, or an obstruction of the intestine, it is called chronic intestinal pseudo-obstruction. The CIPO of the intestine 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 bowel.

causes

There are various possible reasons for a CIPO. The cessation of bowel movement is either muscular or neurogenic. The disease occurs either primarily idiopathically due to 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. Progressive systemic scleroderma is also a possible primary disease. 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.

However, trauma or basic internal diseases such as bronchitis can also set the framework for intestinal pseudo-obstruction, which in principle entails the risk of complications of becoming chronic to the CIPO.

Symptoms, ailments & signs

The clinical picture of a patient with CIPO depends on the primary disease.The localization 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 manifest itself in acute symptoms and thus be accompanied by severe nausea and vomiting. At 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 chronic intestinal pseudo-obstruction.

diagnosis

Diagnosis is easy with 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), toxic megacolon or sigmoid volvulus. In the natural course, a rather unfavorable prognosis applies to the CIPO. Parenteral nutrition is often required after around five years. The therapeutic success often turns out to be unsatisfactory in the long term.

Complications

In the case of chronic intestinal pseudo-obstruction, the patient mainly suffers from complaints in the area of ​​the intestines 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 an intestinal rupture.

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. Life expectancy is usually not affected. After the treatment, the patient can go back to 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. Afterwards, inpatient treatment is usually arranged. Patients who already suffer from bowel disease or diabetic autonomic neuropathy often also develop CIPO. There is also an increased risk of developing chronic intestinal pseudo-obstruction after trauma caused by intestinal surgery or bronchitis.

Anyone who suffers 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.

Doctors & therapists in your area

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. Symptomatic therapy also includes intravenous fluid administration and invasive measures such as parenteral nutrition or the installation of a colon decompression tube or other gastric tubes in the event of 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 to completely resect certain sections of the intestine or to create an enterostomy are only indicated in severe cases. The doctor must carefully weigh the benefits and risks against each other 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 remedied 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 must be started after a few years of initial manifestation.

There is no known prospect of a cure for this disease. Patients 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 due to the lack of symptoms, warnings, or minimal signs. Nevertheless, there is a renewed deterioration in health in the further course.

Chronic intestinal pseudo-obstruction is often not recognized or 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 when chronic intestinal pseudo-obstruction is free from symptoms.

prevention

The chronic intestinal pseudo-obstruction can be prevented to a certain extent. Anyone suffering from intestinal pseudo-obstruction and seeking medical advice in good time, for example, reduces 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.

Aftercare

In most cases, those affected have only a few measures and options for direct follow-up care. 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.

In most cases, this disease is treated by taking various medications. 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 discussions 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 play down the disease. Pure self-treatment is strongly discouraged. Instead, a doctor should be consulted promptly when symptoms occur. If the chronic intestinal pseudo-obstruction is not treated adequately, it can not only lead to severe pain, but in the worst case also to a life-threatening intestinal perforation.

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 advised 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.

Often an intestinal rehabilitation is 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 treating doctor.