chronic idiopathic intestinal pseudo-obstruction (CIIP, CIPO)

Etiology: 1) paraneoplastic syndrome 2) metabolic disorder 3) smooth muscle disorder 4) neuropathy Pathology: 1) fibrosis, muscle atrophy & vacuolar degeneration in the muscularis propria 2) the uterus, bladder & eye may be affected Special laboratory: - upper gastrointestinal endoscopy with manometry of accessible gut a) abnormal motility of the esophagus b) reduced lower esophageal sphincter (LES) pressure c) failure of LES to relax d) small bowel manometry may useful for evaluating effects of promotility agents Radiology: 1) evidence of dilated bowel or ileus without obstruction 2) upper GI series with small bowel follow through & barium enema show patency despite clinical signs of obstruction Management: 1) promotility agents a) metoclopramide b) erythromycin c) bethanechol d) octreotide e) cisapride (removed from US market 7/00) 2) diet a) supplemental nutrition & vitamins b) low fat, low fiber diet c) total parenteral nutrition 3) periodic antibiotics (10-14 days) for bacterial overgrowth 4) surgical bowel resection - colectomy may be curative in patients with disease limited to the colon

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998