J Neurogastroenterol Motil.
2019 Oct;25(4):508-514. 10.5056/jnm19078.
Pyridostigmine in Pediatric Intestinal Pseudo-obstruction: Case Report of a 2-year Old Girl and Literature Review
- Affiliations
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- 1NESMOS Department, School of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
- 2Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II,†Naples, Italy.
- 3Radiology Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy.
- 4Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Italy.
- 5Department of Medical Sciences, University of Ferrara, Ferrara, Italy. dgrrrt@unife.it
- KMID: 2460479
- DOI: http://doi.org/10.5056/jnm19078
Abstract
- Pediatric chronic intestinal pseudo-obstruction is a rare disorder characterized by a severe impairment of gastrointestinal motility leading to intestinal obstruction symptoms in the absence of mechanical causes. The diagnosis is usually clinical and diagnostic work is usually aimed to rule out mechanical obstruction and to identify any underlying diseases. Treatment is challenging and requires a multidisciplinary effort. In this manuscript we describe the youngest child successfully treated with the orally administrable, long-acting, reversible anti-cholinesterase drug, pyridostigmine. Like other drugs belonging to cholinesterase inhibitors, pyridostigmine enhances gut motility by increasing acetylcholine availability in the enteric nervous system and neuro-muscular junctions. Based on the direct evidence from the reported case, we reviewed the current literature on the use of pyridostigmine in severe pediatric dysmotility focusing on intestinal pseudo-obstruction. The overall data emerged from the few published studies suggest that pyridostigmine is an effective and usually well tolerated therapeutic options for patients with intestinal pseudo-obstruction. More specifically, the main results obtained by pyridostigmine included marked reduction of abdominal distension, reduced need of parenteral nutrition, and improvement of oral feeding. The present case and review on pyridostigmine pave the way for eagerly awaited future randomized controlled studies testing the efficacy of cholinesterase inhibitors in pediatric severe gut dysmotility.
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