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Chronic idiopathic intestinal pseudo-obstruction: the need for a multidisciplinary approach to management

Published online by Cambridge University Press:  07 March 2007

D. B. A. Silk
D. B. A. Silk*
Affiliation:
Department of Gastroenterology and Nutrition, Central Middlesex Hospital and Division of Surgery, Anaesthetics and Intensive Care, Imperial College, London, UK
*
Corresponding author: Professor David Silk, fax +1 20 8453 2538.
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Abstract

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At the outset of the research programme into irritable bowel syndrome (IBS) it was perceived that there was a need to develop a symptom-based classification for the patients. Four groups of patients were identified, those with spastic colon syndrome, diarrhoea-predominant spastic colon syndrome, functional diarrhoea and midgut dysmotility. While working with outpatients with IBS it was noted how some of them had suffered symptoms for many years; specifically, a group of patients satisfying the criteria for midgut dysmotility had also suffered from particularly severe and intractable intestinal symptoms. These patients underwent 24 h ambulatory studies of small intestinal motility and the majority were found to have manometric features of chronic idiopathic intestinal pseudo-obstruction (CIIP). To characterise the cause, laparoscopic full-thickness small intestine and colonic biopsies have been obtained in forty-five of the latter group of patients. Of these patients 58% have been found to have complete or partial deficiency of α-actin epitope staining in the inner circular layer of small intestinal smooth muscle. This deficiency is believed to represent an important biomarker rather than the cause of CIIP, since α-actin epitope deficiency has been observed in association with enteric neuropathy and myopathies. In relation to the management of CIIP patients, a multidisciplinary model is proposed incorporating management of co-morbid psychological and psychiatric pathology, abdominal and musculoskeletal pain, fatigue, urological symptoms and nutrition. A six-stage nutritional management plan for these patients is presented.

Keywords

Chronic idiopathic intestinal pseudo-obstructionIrritable bowel syndromeSymptom-based classificationMultidisciplinary management modelNutritional management plan
Type
The Pennington Lecture
Information
Proceedings of the Nutrition Society , Volume 63 , Issue 3 , August 2004 , pp. 473 - 480
Copyright
Copyright © The Nutrition Society 2004

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