Chronic Intestinal Pseudo-Obstruction

Abstract

Chronic intestinal pseudo-obstruction (CIPO) includes a heterogeneous group of disorders characterized by clinical symptoms of either continuous or intermittent bowel obstruction in the absence of mechanical obstruction. Pathophysiologically, CIPO shows ineffective intestinal propulsion due to an impairment of the enteric nervous system, intestinal smooth muscle, and/or interstitial cells of Cajal (ICC). Common symptoms include abdominal pain, nausea, vomiting, bloating, dysphagia, constipation, and involuntary weight loss depending on the location and degree of gastrointestinal tract involvement. Unfortunately, the non-specific nature of the symptoms, rarity of the disease, and the lack of awareness often lead to misdiagnosis or delay in diagnosis and treatment. The diagnostic workup should include imaging, manometry studies, and, occasionally, full-thickness bowel biopsies alongside workup to determine secondary causes. Treatment goals should include optimizing the nutritional status, avoiding surgery, and preventing or delaying the development of intestinal failure.