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Chronic intestinal pseudo-obstruction


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The following summarized guidelines for the evaluation and management of chronic intestinal pseudo-obstruction are prepared by our editorial team based on guidelines from the British Society of Gastroenterology (BSG 2020) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN 2018). ...
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Screening and diagnosis

Diagnosis: as per BSG 2020 guidelines, make a definite diagnosis only when a detailed history, symptoms, and investigations (including histology in a unit with expertise in this area of pathology) confirm the diagnosis. Consider making an empirical working diagnosis of probable severe dysmotility if a definitive diagnosis is not possible.
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  • Etiology

Diagnostic investigations

Initial evaluation: as per BSG 2020 guidelines, obtain workup judiciously, including radiology, radioisotope studies, manometry, autoimmune screens, and histology, in accordance with current guidelines. Take into account the presence of some drugs (such as opioids, cyclizine, or anticholinergic drugs), severe malnutrition, or an eating disorder when interpreting results.
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Medical management

General principles: as per BSG 2020 guidelines, ensure multidisciplinary team management (likely to include a gastroenterologist, gastrointestinal physiologist, gastrointestinal surgeon, pain team, psychiatrist/psychologist, rheumatologist, urologist, gynecologist, radiologist, dietitian, specialist nurses, clinical biochemist, histopathologic, and pharmacist) in patients with chronic small intestinal dysmotility as these patients are complex with multiple issues contributing to their presentation. Encourage regional networking (can be via a virtual multidisciplinary team) both for support/guidance and to collect data.
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Nonpharmacologic interventions

Nutritional support: as per BSG 2020 guidelines, offer oral supplements/dietary adjustments in patients with or at risk of malnutrition.
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Therapeutic procedures

Venting gastrostomy: as per BSG 2020 guidelines, consider placing venting gastrostomy to reduce vomiting in patients with chronic small intestinal dysmotility recognizing associated problems (leakage, not draining, or poor body image).

Specific circumstances

Pediatric patients, definition: as per ESPGHAN 2018 guidelines, view chronic intestinal pseudo-obstruction occurring in infants and children as a separate entity from that in adults and refer to as pediatric intestinal pseudo-obstruction.
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  • Pediatric patients (diagnosis)

  • Pediatric patients (differential diagnosis)

  • Pediatric patients (initial imaging)

  • Pediatric patients (assessment of bowel transit)

  • Pediatric patients (intestinal biopsy)

  • Pediatric patients (laboratory tests)

  • Pediatric patients (nonoperative management)

  • Pediatric patients (nutrition)

  • Pediatric patients (stoma creation)

  • Pediatric patients (surgical management)

  • Pediatric patients (transition of care)

  • Pediatric patients (national regulations)