J Neurogastroenterol Motil.  2023 Jul;29(3):378-387. 10.5056/jnm22152.

Natural History of Chronic Intestinal Pseudo-obstruction and Need for Palliative Care

• Tanaka K
• Ohkubo H
• Yamamoto A
• Takahashi K
• Kasai Y
• Ozaki A
• Iwaki M
• Kobayashi T
• Yoshihara T
• Misawa N
• Fuyuki A
• Kato S
• Higurashi T
• Hosono K
• Yoneda M
• Kurihashi T
• Taguri M
• Nakajima A
• Gwee KA
• Kessoku T

• KMID: 2544720
• DOI: http://doi.org/10.5056/jnm22152

Abstract

Background/Aims
Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients.
Methods
From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course.
Results
Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m² , 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care.
Conclusion
CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

Keyword

Decompression; Depression; Intestinal pseudo-obstruction; Palliative care; Total parenteral nutrition