Analgesics, antiemetics, antisecretory, antispasmodics, prokinetic agents, laxatives, or antidiarrheal medications may be used to help manage the symptoms of CIPO.
[4] Symptoms of chronic intestinal pseudo-obstruction can vary depending on which segment of the gastrointestinal tract is most involved and may evolve as the disease progresses.
[5] Patients with chronic intestinal pseudo-obstruction that involves the small bowel commonly present with symptoms such as constipation, abdominal pain, nausea, and vomiting.
[3] In patients with primarily gastric involvement, postprandial bloating, early satiety, pain in the abdomen, nausea, and vomiting may be present along with significant gastroparesis.
Adult pseudo-obstruction's most frequent secondary causes include radiation enteritis, amyloidosis, paraneoplastic syndromes, hypothyroidism, usage of substances with anticholinergic or narcotic effects, diabetes, scleroderma, and other connective tissue disorders.
[3] Recently, viral infections such as Epstein-Barr virus,[11] Herpes Zoster, and Cytomegalovirus have drawn attention as potential causes of pseudo-obstruction.
[19][5] Enteric neuropathies may share pathogenetic processes with central nervous system neurodegenerative illnesses due to their close similarities.
Significant changes in the ICC enteric network highlight the important involvement of nonneuronal cells in regulating gut motility.
[22][23] The diagnosis of CIPO is mostly clinical, backed by radiographic documentation of dilated bowel with air-fluid level after exclusion of organic lesions obstructing the gut lumen, as determined by radiologic and/or endoscopic examinations.
[26] Afterwards, additional information is obtained by abdominal computed tomography (CT) imaging in order to rule out an extraluminal, gut wall, or intraluminal mechanically obstructive lesion.
[17] As a result, tests should be performed for serum glucose, thyroid-stimulating hormone, albumin, liver enzymes, vitamin B12, total blood count, and inflammatory markers (such as C-reactive protein and erythrocyte sedimentation rate).
Following diagnosis, treatment goals should include preventing needless surgery, reestablishing electrolyte and fluid balance, enhancing nutritional status, managing infections, and reducing pain, nausea, vomiting, and bloating symptoms.
Patients should be urged to eat small, frequent meals (five to six times a day), emphasizing protein and liquid calories, and to stay away from high-fiber and fat items.
This is because parenteral nutrition has been linked to pancreatitis, thrombus formation, cellulitis, sepsis, and nonalcoholic fatty liver disease, which can progress to fibrosis and cirrhosis.
[34] Unfortunately, because to the degenerative nature of the condition and the absence of viable treatments, many CIPO patients may eventually need parenteral nutrition.
Patients may experience symptom-free intervals followed by periods of severe symptoms that require emergency room visits and hospitalizations.
[27] According to one study, only 11% of people with CIPO experience asymptomatic periods between subacute obstructive episodes and do not need ongoing medical treatment.
[27] A review of 378 institutions by the Japanese Society of Gastroenterology found only 160 cases with suspected CIPO, with 138 (86.3%) meeting the rigorous criteria.