Dysmotility disorders: a nutritional approach.

PURPOSE OF REVIEW: Chronic intestinal pseudo-obstruction (CIPO) results in markedly compromised peristalsis mimicking an intestinal occlusion. The main goals of CIPO management are to improve intestinal propulsion and to maintain adequate nutrition status. The review describes the global management of CIPO including methods of diagnosis and nutritional, pharmacological and surgical therapies.

RECENT FINDINGS: The principles of CIPO management are to perform a physiological assessment of the gastrointestinal tract involved, to improve symptoms and to prevent malnutrition. We shall discuss the place of physiological motility tests such as intestinal manometry and the cine-magnetic resonance imaging to facilitate diagnosis. Home parenteral nutrition (HPN) is a frequently used therapy with a high dependence level. However, recent data are consistent with a good long-term prognosis. Currently, CIPO becomes a significant cause of chronic intestinal failure. We discuss the outcomes of HPN and surgery.

SUMMARY: CIPO is a rare and complex disease. Small bowel manometry remains a gold standard for diagnosis, but new imaging tools appear promising. The management of CIPO requires the cooperation of specialists involved in the intestinal failure field. The better knowledge of CIPO prognosis should encourage clinicians to propose intestinal transplantation in selected cases.