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Chronic intestinal pseudo-obstruction (CIPO) is a rare and heterogeneous syndrome : A Part from the Book Chapter : Role of Gut Microbota in Etiopathogenesis of Chronic Intestinal Psueudo Obstruction

Chronic Intestinal Pseudo-Obstruction

Chronic intestinal pseudo-obstruction (CIPO) is a rare and heterogeneous syndrome characterized by recurrent symptoms of intestinal obstruction with radiological features of dilated small or large intestine with air/fluid levels in the absence of any mechanical occlusive lesions. CIPO affects both pediatric and adult patients and it can be primary, secondary, or idiopathic in origin. The underlying histopathology may reveal a variety of neuropathy, myopathy, mesenchymopathy or a combination of such abnormalities, e.g. neuro-myopathies. CIPO is considered the most severe phenotypic presentation of intestinal dysmotility and should be distinguished from other gastrointestinal conditions, such as enteric dysmotility in which intestinal motility is also severely impaired, but dilatation of the intestine and radiological signs of intestinal obstruction are absent. Clinicians do not have unique effective diagnostic tools for CIPO patients, and the most advanced available treatments could only relieve patients’ symptoms. This leads to a late diagnosis and an increased mortality rate for these patients. Motility in the GI tract is controlled by the enteric nervous system (ENS). The ENS acts in concert with enteroendocrine cells (EECs), a large number of cells widely distributed throughout the epithelial lining which secrete bioactive messengers/hormones, to regulate various gut functions, including motility, and monitor the endoluminal ecosystem. With over 100 trillion of microbial cells in mutualistic association with our intestine, the gut microbiota influences there are the GI physiology, metabolism, nutrition and immune function of the host. Gut functions are strongly influenced by gut microbiota a complex microbial ecosystem that include Bacteria, Archaea, Eucarya and virus all co-evolved with the host over thousands of years assembling a complex and mutualistic rapport. Gut microbiota role, in intestinal motility disorder, should not be neglected. Several studies indicate that gut microbiota interfere with gastrointestinal motility by different mechanisms, and current discoveries on the inter-relationships between bacteria, viruses, and parasites and the ENS are clearly reported in the recent review by Mauro Giuffrè and collegues. In this narrative review, we will discuss current literature regarding the relationship between gut microbiota, CIPO patients and intestinal motility, suggesting that future studies could be important for better comprise the causes of intestinal motility dysfunction in CIPO patients.

Author(s) Details:

Giulia Radocchia
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy

Bruna Neroni
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy

Massimiliano Marazzato
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy

Elena Capuzzo
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy

Simone Zuccari
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy

Fabrizio Pantanella
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy

Letizia Zenzeri
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy and Paediatric Emergency Department, Santobono-Pausilipon Children’s Hospital, Naples, Italy

Melania Evangelisti
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.

Francesca Vassallo
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.

Pasquale Parisi
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.

Giovanni Di Nardo
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.

Serena Schippa
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy


Also See : The Medicinal Properties of the Olive Tree : A Part from the Book Chapter : Antioxidant Properties and Protective Effect of Phenolic Extracts of Olive Leaves and Olive Mill Wastewater against Lipid Peroxidation


Recent Global Research Developments in Chronic Intestinal Pseudo-Obstruction: Mechanisms, Diagnosis, and Treatment

Epidemiology:

CIPO is uncommon, with estimated prevalence ranging from 0.80 to 1.00 per 100,000 individuals in Japan.

The mean age at diagnosis is around 60 years.

Bowel dilation can affect the small bowel, colon, or both. Delayed gastric emptying may also occur.

Pathogenesis:

CIPO can result from various factors:

Neuropathic disorders involving the enteric or extrinsic nervous system.

Myopathic disorders affecting smooth muscle.

Abnormalities in interstitial cells of Cajal (ICC).

Functional abnormalities in small intestinal biopsies include decreased purinergic neuromuscular transmission [1].

Management:

Treatment strategies focus on optimizing nutritional status (oral, enteral, and parenteral), improving intestinal motility, and considering endoscopic or surgical options [1,2].

Specific management for CIPO, acute colonic pseudo-obstruction, and slow transit constipation are discussed separately.

References

  1. Laique, S.N., Gabbard, S.L. (2019). Chronic Intestinal Pseudo-Obstruction. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_5
  2. Camilleri, M. (2023). Chronic intestinal pseudo-obstruction: Etiology, clinical manifestations, and diagnosis.

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