Chronic intestinal pseudo‐obstruction: Progress in management?

Chronic intestinal pseudo‐obstruction (CIPO) is a severe form of gastrointestinal dysmotility (often due to derangement of the innervation/smooth muscle/interstitial cells of Cajal) with recurrent episodes of intestinal subocclusion mimicking a mechanical obstruction. Because of its complexity and heterogeneity, CIPO is often misdiagnosed or remains unrecognized until advanced stages. Management is a critical aspect in CIPO patient care. So far, most prokinetic drugs have not proven efficacy in restoring intestinal propulsion, thus nutritional support, fluid/electrolyte replacement, and antibiotics are the mainstay of treatment. In this issue of the journal, Ohkubo et al showed promising data indicating that percutaneous endoscopic gastro‐jejunostomy (PEG‐J) can be proposed as a measure for intestinal decompression, thereby improving CIPO‐associated abdominal symptoms, including pain. In addition to a concise update of clinical and diagnostic features, the present minireview tackles management options, with a major emphasis on PEG‐J, for CIPO patients. Abbreviated : Chronic intestinal pseudo‐obstruction (CIPO) is one of the most severe forms of gastrointestinal dysmotility with many debilitating and potentially life‐threatening symptoms / manifestations. Since most drugs failed to restore gastrointestinal coordinated motility, nutritional support, fluid / electrolyte replacement and antibiotics are still mandatory as life‐saving measures. Promising data indicate that percutaneous endoscopic gastro‐jejunostomy (PEG‐J) can be proposed as a measure for intestinal decompression in CIPO, thereby improving symptoms and preventing malnutrition.