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Chronic Intestinal Pseudo-Obstruction

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When your child has a colorectal condition, we know you want the best possible care for them. That’s why the experts at the CHOC Colorectal and Urogenital Center provide you and your family with the highest quality support from diagnosis to long-term care. Our dedicated team of pediatric experts in several specialties work together to ensure specialized treatment tailored to your family’s needs.

What is chronic intestinal pseudo-obstruction (CIPO)?

CIPO is a rare and serious condition that affects the movement of the digestive tract, including areas from the esophagus to the rectum and sometimes the bladder. This disorder causes the muscle contractions that normally move food through the intestines to become weak and uncoordinated, mimicking the symptoms of a physical blockage, though none is present.

Causes of chronic intestinal pseudo-obstruction

CIPO can result from muscle and nerve function issues in the intestines. It’s categorized into two types:

Primary CIPO: Congenital or resulting from injuries to the intestine’s muscle or nerves
Secondary CIPO: Develops from conditions such as viral infections, autoimmune disorders or metabolic disorders.

The Causes of CIPO vary. Some cases are caused by genetics, but in many cases the exact cause remains unidentified.

Symptoms of chronic intestinal pseudo-obstruction

The symptoms of CIPO can change based on the affected area of the intestine. Resulting issues are similar to a blockage, including:

Abdominal pain
Nausea or vomiting
Diarrhea
Constipation
Variations in bowel movements
Bloating or distended abdomen.

Symptoms can range from mild and sporadic to severe, potentially causing critical health complications in young children, such as malnutrition due to poor nutrient absorption and bacterial infections.

Diagnosing chronic intestinal pseudo-obstruction

Diagnosing CIPO involves a thorough medical history and physical examination to identify any risk factors or symptoms typical of CIPO. This process may include a variety of diagnostic tests, such as imaging to check for abnormalities in the abdomen and motility studies across different parts of the gastrointestinal tract to assess the movement of food. Specific tests such as antroduodenal and colonic manometry measure bowel pressures to confirm CIPO. In unique situations, a laparotomy might be performed to inspect and take samples from the intestines directly.

Treatment of chronic intestinal pseudo-obstruction

Proper medical treatment can help stabilize the condition of pseudo-obstruction, as there is currently no known cure. This can prevent complications and improve your child’s quality of life, allowing them to participate in typical childhood activities.

Treatment options may include:

Prokinetic medications that can aid intestinal contractions and improve motility in some children
Antibiotics, when intestinal bacterial overgrowth is suspected
Anti-nausea medications, anti-diarrheal medications or laxatives, when appropriate
Medicines that target pain; however, pain medications can also slow digestion and are used sparingly for children with CIPO.

Specific medications and treatment regimens used are based on each child’s individual history.

It is crucial to provide proper nutrition to children with CIPO. Nutritional rehabilitation is a top priority for these children. It is recommended that they consume several small meals throughout the day consisting of easy-to-digest and pureed foods. In some cases, children may be unable to consume even small meals by mouth. In these cases, nutrition is given to them through a feeding tube or intravenous delivery, depending on the severity of the case.

In certain situations, the release of pressure from the intestines may require surgical decompression. This can be achieved by inserting a feeding tube directly into the stomach or by creating an opening in the abdomen through which the intestines can expel gas and empty stool.

In severe and uncommon cases, transplantation of the small bowel may be necessary to replace the intestines and potentially other organs.

Long-term care and management of chronic intestinal pseudo-obstruction

Experts at the CHOC Colorectal and Urogenital Center have vast experience in diagnosing and treating CIPO caused by various underlying factors and conditions. Early detection and management of these factors can improve symptoms and quality of life in children with CIPO. At CHOC, we provide comprehensive care to every patient, including medical, pharmaceutical, nutritional and surgical management of CIPO and underlying conditions. Our dedicated team of experts collaborates closely with families to ensure the best possible outcomes, emphasizing the significance of early detection and specialized care tailored to each child’s unique needs.

Learn more about the CHOC Colorectal and Urogenital Center.