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. 2023 Jul 30;29(3):378-387.
doi: 10.5056/jnm22152.

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

Kosuke Tanaka  1   2 , Hidenori Ohkubo  2   3 , Atsushi Yamamoto  2 , Kota Takahashi  2 , Yuki Kasai  2 , Anna Ozaki  2 , Michihiro Iwaki  2 , Takashi Kobayashi  2 , Tsutomu Yoshihara  2 , Noboru Misawa  2 , Akiko Fuyuki  2 , Shingo Kato  2   4 , Takuma Higurashi  2 , Kunihiro Hosono  2 , Masato Yoneda  2 , Takeo Kurihashi  5 , Masataka Taguri  6 , Atsushi Nakajima  2 , Kok-Ann Gwee  7   8   9 , Takaomi Kessoku  1   2   10
Affiliations

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

Kosuke Tanaka et al. J Neurogastroenterol Motil. .

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.

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

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Conflict of interest statement

Conflicts of interest: Atsushi Nakajima receives grants and research support from Gilead, Mylan EPD, EA Pharma, Kowa, Taisho, and Biofermin, and is a consulting adviser for Gilead, Boehringer Ingelheim, BMS, Kowa, Astellas, EA Pharma, and Mylan EPD. The remaining authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Survival rate of patients with chronic intestinal pseudo-obstruction.
Figure 2
Figure 2
Treatment strategy for patients with chronic intestinal pseudo-obstruction. HBT, hydrogen breath test; SIBO, small intestinal bacterial overgrowth; MNZ, metronidazole; VCM, vancomycin; RFX, rifaximin; TPN, total parenteral nutrition; PEG-J, percutaneous endoscopic gastro-jejunostomy.
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