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What is Chronic Intestinal Pseudo Obstruction?
Chronic Intestinal Pseudo Obstruction, known as CIPO, is a disorder of the gut’s motility. It happens when the nerves and/or muscles in the gut don’t work properly so it is difficult or impossible to move food, fluids and air through the digestive system.
CIPO arising in the nerves is termed neuropathic, and in the muscles myopathic.
CIPO usually affects the small and large bowel, though some people experience difficulties with the oesophagus and/or stomach. The disorder is termed “pseudo-obstruction” because symptoms are very like having a blockage in some part of the digestive system, but there is nothing physically present.
Symptoms of Chronic Intestinal Pseudo Obstruction
The symptoms of CIPO can be very similar to a variety of other conditions of the digestive system, such as IBS, colorectal (bowel) cancer and Inflammatory Bowel Disease (Colitis and Crohn’s disease). These include:
- Abdominal pain
- Abdominal distention
- High volume vomiting
- Severe constipation or diarrhoea
- Bladder problems (including urine retention, urinary tract infections and incontinence)
- dysphagia (problems with swallowing) in some cases
Diagnosis of Chronic Intestinal Pseudo Obstruction
There is no single test that definitively confirms a diagnosis of CIPO. Several are currently used and it is best to be seen by a gastroenterologist who has an interest in motility disorders because CIPO is a complex condition that is often poorly understood.
Two key current tests include small bowel manometry, where a tube is passed through the nose, down the throat, into the stomach and through to the small bowel. Here sensors in the tube measure the contractions of the bowel wall. The second is full-thickness biopsy where, under general anaesthetic, a small piece of the full thickness of the bowel is removed for analysis.
Other tests are used mostly to rule out other conditions and include endoscopy, electrogastrogram, PH probe, oesophagal manometry, barium swallow and follow-through, videofluoroscopy and anorectal manometry among others.
The GI Physiology Unit a specialist neurogastroenterology department at Queen Mary University has some useful patient information materials relating to some of these tests.
Treatment of Chronic Intestinal Pseudo Obstruction
Treatments vary widely and depend on the individual and their particular manifestation of the condition. Treatment ranges from drug treatments for symptoms such as constipation or nausea to medications which speed up the passage of food through the gut and antispasmodics, to surgical and dietary interventions, for example the FODMAP diet.