Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Nutrition. 2010 May;26(5):502-5. doi: 10.1016/j.nut.2009.07.012. Epub 2009 Dec 16.
Chronic intestinal pseudo-obstruction (CIPO) is a rare intestinal motility disorder. A prolonged avoidance of food due to fear of aggravation of postprandial symptoms leads to severe malnutrition. We report a case of a 21 y old man who was diagnosed as CIPO with a history of recurrent intestinal colic and obstructive symptoms, slow transit type of constipation, bilateral hydronephrosis (non-obstructive), motor dysphagia without any evidence of demonstrable mechanical obstruction. Our aim was to keep his post prandial symptoms to a minimum and nutritionally build him up with enteral nutrition (EN).
He had life threatening malnutrition (BMI of 11 kg/m(2)) and significant postprandial distension with an intake more than 100 ml, compromising the quality of life. In view of a normal absorptive function of the gut, TPN was ruled out and the patient was treated with enteral nutrition (oral & tube) only. The EN regimen followed was ad libitum oral intake along with nocturnal NG tube feeding. Initially a full strength semi-elemental formula at 50 ml/hour was given, later shifted to polymeric formula at 100 ml/hour. Serum levels of magnesium, phosphate and potassium were regularly monitored to prevent refeeding syndrome. He ws constantly motivated, counseled and monitored.
With a gradual increase in the intake from 300 Kcal to 1400 Kcal he was discharged. Eight months from discharge he had a weight of 58 kg (BMI = 22.3 kg/m(2)), with resumption of normal activities and marked improvement in the quality of life.
Carefully planned EN along with motivation, psychological support and regular monitoring are the keys to nutritional management in CIPO.
慢性假性肠梗阻（CIPO）是一种罕见的肠道动力障碍。由于担心餐后症状加重，患者可能会长期避免进食，从而导致严重的营养不良。我们报告了 1 例 21 岁男性患者，其病史为反复发作性肠绞痛和梗阻症状、慢传输型便秘、双侧肾积水（非梗阻性）、运动性吞咽困难，但无明显机械性梗阻的证据。我们的目标是尽量减少患者的餐后症状，并通过肠内营养（EN）为其提供营养。
患者存在危及生命的营养不良（BMI 为 11kg/m²），且餐后腹胀严重，摄入量超过 100ml，严重影响生活质量。鉴于肠道具有正常的吸收功能，排除了全肠外营养（TPN），仅采用肠内营养（口服和管饲）进行治疗。采用自由口服和夜间经鼻胃管喂养的方式进行 EN 治疗。最初以 50ml/h 的速度给予全营养半要素配方，随后改为 100ml/h 的聚合物配方。定期监测血清镁、磷和钾水平，以预防再喂养综合征。对患者进行持续的激励、指导和监测。
随着摄入量从 300 千卡逐渐增加到 1400 千卡，患者出院。出院 8 个月后，患者体重为 58kg（BMI=22.3kg/m²），恢复了正常活动，生活质量得到显著改善。
精心计划的 EN 治疗，并辅以激励、心理支持和定期监测，是 CIPO 营养管理的关键。
