chronic idiopathic intestinal pseudo-obstruction (CIIP, CIPO)

Etiology

• paraneoplastic syndrome
• metabolic disorder
• smooth muscle disorder
• neuropathy

Pathology

• fibrosis, muscle atrophy & vacuolar degeneration in the muscularis propria
• the uterus, bladder & eye may be affected

Diagnostic procedures

• upper gastrointestinal endoscopy with manometry of accessible gut
  • abnormal motility of the esophagus
  • reduced lower esophageal sphincter (LES) pressure
  • failure of LES to relax
  • small bowel manometry may useful for evaluating effects of promotility agents

Radiology

• evidence of dilated bowel or ileus without obstruction
• upper GI series with small bowel follow through & barium enema show patency despite clinical signs of obstruction

Management

• promotility agents
  • metoclopramide
  • erythromycin
  • bethanechol
  • octreotide
  • cisapride (removed from US market 7/00)
• diet
  • supplemental nutrition & vitamins
  • low fat, low fiber diet
  • total parenteral nutrition
• periodic antibiotics (10-14 days) for bacterial overgrowth
• surgical bowel resection
  • colectomy may be curative in patients with disease limited to the colon

More general terms

• intestinal pseudo-obstruction