Esophageal High-Resolution Manometry for Diagnosing the Severity of the Chronic Intestinal Pseudo-Obstruction: A Case Series

Background Chronic intestinal pseudo-obstruction (CIPO) is a severe and refractory intestinal motility disorder. However, due to its rarity and difficult histological investigation, its pathophysiology has not been characterized. Aim Therefore, in this study, we aimed to determine the role of esopha...

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Bibliographic Details
Published in:Digestive diseases and sciences 2021-11, Vol.66 (11), p.3960-3967
Main Authors: Sato, Hiroki, Kamimura, Kenya, Matsui, Hideaki, Owaki, Takashi, Morita, Shinichi, Tanaka, Yuto, Ishikawa, Natsuki, Shimada, Yoshifumi, Yokoyama, Junji, Wakai, Toshifumi, Terai, Shuji
Format: Article
Language:English
Subjects:
Abdomen
Analysis
Appendicitis
Biochemistry
Colon
Disease
Esophagus
Gastroenterology
Health aspects
Hepatology
Investigations
Medical diagnosis
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Motility
Oncology
Original Article
Pain
Parenteral nutrition
Pathophysiology
Small intestine
Surgery
Transplant Surgery
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Summary:Background Chronic intestinal pseudo-obstruction (CIPO) is a severe and refractory intestinal motility disorder. However, due to its rarity and difficult histological investigation, its pathophysiology has not been characterized. Aim Therefore, in this study, we aimed to determine the role of esophageal high-resolution manometry (HRM) in CIPO and the histological and clinical characteristics of the disease. Methods Patients with CIPO were analyzed for clinical characteristics; histological findings; and clinical courses after therapeutic intervention. In addition, HRM was performed to determine the esophageal involvement. Results Eleven patients were diagnosed with CIPO, and five required the long period of parenteral nutrition showing impaired esophageal motility including achalasia and absent contractility diagnosed with HRM. The four of these five cases showed acute onset of the CIPO following the triggering events of pregnancy, appendicitis, and surgery. In contrast, other six patients with normal or Jackhammer esophagus on HRM had moderate severity of CIPO with gradual onset. The histological analyses revealed that the loss of the intestinal neural ganglion cells and layers by inflammation, destruction, and atrophy are related to the severity of the clinical course of the disease and esophageal HRM findings of achalasia and absent contractility. Conclusions HRM may be useful to diagnose the severity of the clinical course and to determine the therapeutic options for CIPO.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-020-06701-9