Original articleClinical, Radiologic, and Manometric Characteristics of Chronic Intestinal Dysmotility: The Stanford Experience
Section snippets
Patients
We reviewed the medical records of 113 patients with the diagnosis of CID. All patients had recurrent symptoms suggestive of bowel obstruction in the absence of a mechanical occlusion. The manometric criteria for the diagnosis of CID as originally proposed by the Mayo Clinic11 (see below) were fulfilled by all 113 patients (19 male, 94 female; median age, 43 years [range, 18–80 years]). These patients were evaluated and managed at the Stanford Hospital GI Motility Center between 1999 and 2004.
Clinical Presentation
The median age of symptom onset was 37 years (range, 8–77 years). Figure 1 shows the distribution of GI symptoms at presentation. The median scores for each symptom were 3 for abdominal distention, abdominal pain, and bloating; 2 for nausea and constipation; 1 for vomiting, diarrhea, and heartburn; and 0 for dysphagia. Systemic or non-GI symptoms included weight loss (in 64%), fatigue (in 12%), arthralgia (in 11%), orthostatic hypotension (in 10%), weakness (in 10%), myalgia (in 10%), urinary
Discussion
Our cohort study suggests that adults with CID have multiple GI symptoms, including abdominal distention, pain, nausea, and others, as well as non-GI symptoms, including urologic, rheumatologic, and neurologic symptoms. Because any segment of the GI tract or the entire GI tract may be involved in adult CID, a functional assessment of the entire GI tract is recommended.
In our study, the diagnosis of CID was made on the basis of suggestive symptoms, exclusion of mechanical obstruction by
References (44)
- et al.
Urological manifestations associated with chronic intestinal pseudo-obstruction in children
J Urol
(2002) - et al.
Familial visceral neuropathy with autosomal dominant transmission
Gastroenterology
(1986) - et al.
Studies of idiopathic intestinal pseudoobstruction. Hereditary hollow visceral myopathy: family studies
Gastroenterology
(1977) - et al.
Natural history of chronic idiopathic intestinal pseudo-obstruction in adultsa single-center study
Clin Gastroenterol Hepatol
(2005) - et al.
Determinants of response to a prokinetic agent in neuropathic chronic intestinal motility disorder
Gastroenterology
(1994) - et al.
Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction
Gastroenterol Clin North Am
(2003) - et al.
Jejunal manometry patterns in health, partial intestinal obstruction, and pseudo-obstruction
Gastroenterology
(1983) - et al.
Scintigraphy of the whole gutclinical evaluation of transit disorders
Mayo Clin Proc
(1995) - et al.
Intraluminal pressure recordings from human sphincter of Oddi
Gastroenterology
(1980) - et al.
Effect of six weeks of treatment with cisapride in gastroparesis and intestinal pseudo-obstruction
Gastroenterology
(1989)
Abnormal post-cibal antral and small bowel motility due to neuropathy or myopathy in systemic sclerosis
Gastroenterology
Chronic intestinal pseudo-obstruction syndromes
Med Clin North Am
Impaired transit of chyme in chronic intestinal pseudo-obstructioncorrection by cisapride
Gastroenterology
Ileo-colonic transfer of solid chyme in small intestinal neuropathies and myopathies
Gastroenterology
Chronic intestinal pseudo-obstructiontreatment and long-term follow up of 44 patients
Arch Dis Child
Infantile chronic idiopathic intestinal pseudo-obstructionthe role of small intestinal manometry as a diagnostic tool and prognostic indicator
Gut
Long-term outcome of congenital intestinal pseudo-obstruction
Dig Dis Sci
Familial enteric neuropathy with pseudo-obstruction
Dig Dis Sci
Familial visceral myopathya family with involvement of four generations
Dig Dis Sci
Chronic intestinal pseudo-obstructiona report of 27 cases and review of the literature
Medicine
Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults
Gut
Chronic idiopathic intestinal pseudo-obstructionclinical and intestinal manometric findings
Gut
Cited by (37)
The chronic intestinal pseudo-obstruction subtype has prognostic significance in patients with severe gastrointestinal dysmotility related intestinal failure
2018, Clinical NutritionCitation Excerpt :Meanwhile, ED is defined by demonstrable abnormal small bowel motor activity but without any features mimicking mechanical obstruction [6,10–13]. However, there remains considerable debate on the merits of sub-classifying severe gastrointestinal motility disorders into CIPO and ED and, as a result, these disorders are typically grouped together under the encompassing term 'chronic intestinal dysmotility' by clinicians and researchers [14–16]. In addition to the clinical sub-classification, it is recognised that patients with GID have a high incidence of gastrointestinal neuromuscular disorders (GINMD) on full-thickness histopathology biopsies (FTB) [17].
Clinical and Translational Aspects of Normal and Abnormal Motility in the Esophagus, Small Intestine and Colon
2018, Physiology of the Gastrointestinal Tract, Sixth EditionA practical review of gastrointestinal manifestations in Parkinson's disease
2017, Parkinsonism and Related DisordersCitation Excerpt :For this, multiple validated scales are available. Although we use our own scale tracking multiple GI symptoms at once [43,44] many other scales have been validated and used widely, including the Sialorrhea Clinical Scale for PD [45], the Generic Scale for Dysphagia-Related Outcomes Quality of Life [46–48], and the Cleveland Constipation Scoring System [49]. The physical examination should be comprehensive.
Elderly male with respiratory failure
2012, Annals of Emergency MedicineCitation Excerpt :Chronic idiopathic intestinal pseudo-obstruction is a rare syndrome characterized by impaired gastrointestinal propulsion with symptoms and signs of bowel obstruction in the absence of organic, systemic, or metabolic disorders.1,2 The dysfunction of enteric, extrinsic nervous system and smooth muscle contractility of the gut leads to food restriction, enteral or parenteral nutrition dependency, and rarely cardiopulmonary complications.2,3 Although patients can be successfully managed nonsurgically,4 50% to 70% need a surgical intervention because of failure of medical treatment or as a result of severe complications.5,6
Pseudo-obstruction, enteric dysmotility and irritable bowel syndrome
2019, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :The availability of small bowel manometry is limited to highly specialized units and there is an unmet need for more accessible methods for diagnosing enteric dysmotility. Transit studies showing delayed transit using contrast radiography or radio-opaque markers [51,52] have been used in more severe cases of dysmotility and recently the wireless motility capsule was shown to identify general dysmotility in patients with diabetes mellitus [53]. No controlled studies have been performed to assess the usefulness of pharmacological agents in patients with enteric dysmotility.
Relationship of Age and Gender to Motility Test Results and Symptoms in Patients with Chronic Constipation
2024, Digestive Diseases and Sciences
Dr Rosa-e-Silva was supported by a grant from the Capes-Coordenaçaô de Aperfeiçoamento de Pessoal de Nível Superior and from the Universidade Estadual de Londrina-Brazil to serve as a visiting scholar at the Division of Gastroenterology and Hepatology, Stanford University. Dr Triadafilopoulos is a Consultant to almost all the major pharmaceutical companies that are active in the area of gastroesophageal reflux. He has received funding for studies, seminars, and travel from such companies and has an equity position in Curon Medical, Inc. His research is supported by the National Institutes of Health (DK063624).