Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic.
Neurogastroenterol Motil. 2017 Nov;29(11). doi: 10.1111/nmo.13120. Epub 2017 Jun 5.
Colonic pseudo-obstruction (CPO) is characterized by colonic distention in the absence of mechanical obstruction or toxic megacolon. Concomitant secretory diarrhea (SD) with hypokalemia (SD-CPO) due to gastrointestinal (GI) loss requires further characterization.
To perform a systematic review of SD-CPO, report a case study, and compare SD-CPO with classical CPO (C-CPO).
We performed a search of MEDLINE, EMBASE, Cochrane, and Scopus for reports based on a priori criteria for CPO, SD and GI loss of potassium. An additional case at Mayo Clinic was included.
Nine publications met inclusion criteria, with a total of 14 cases. Six studies had high, three moderate, and our case high methodological quality. Median age was 74 years (66-97), with 2:1 male/female ratio. Kidney disease was present in 6/14 patients. Diarrhea was described as profuse, watery, or viscous in 10 patients. Median serum, stool, and urine potassium concentrations (mmol/L) were 2.4 (range: 1.9-3.1), 137 (100-180), and 17 (8-40), respectively. Maximal diameter of colon and cecum (median) were 10.2 cm and 10.5 cm, respectively. Conservative therapy alone was effective in five out of 14 patients. Median potassium supplementation was 124 mEq/d (40-300). Colonic decompression was effective in three out of six patients; one had a total colectomy; three out of 14 had died. The main differences between SD-CPO and C-CPO were lower responses to treatments: conservative measures (35.7% vs 73.6%, P=.01), neostigmine (17% vs 89.2%, P<.001), and colonic decompression (50% vs 82.4%, P=.02).
SD-CPO is a rare phenotype associated with increased fecal potassium and is more difficult to treat than C-CPO.
结肠假性梗阻 (CPO) 的特征是在没有机械梗阻或中毒性巨结肠的情况下出现结肠扩张。伴有胃肠道 (GI) 丢失导致低钾的分泌性腹泻 (SD) (SD-CPO) 需要进一步描述。
对 SD-CPO 进行系统综述，报告一个病例，并将 SD-CPO 与经典 CPO (C-CPO) 进行比较。
我们根据预先设定的 CPO、SD 和 GI 钾丢失标准，在 MEDLINE、EMBASE、Cochrane 和 Scopus 中进行了检索。还包括梅奥诊所的一个附加病例。
9 篇文献符合纳入标准，共 14 例。6 项研究具有较高的方法学质量，3 项为中等，我们的病例为高。中位年龄为 74 岁 (66-97)，男女比例为 2:1。14 例患者中有 6 例存在肾脏疾病。10 例患者腹泻描述为大量、水样或粘性。血清、粪便和尿液钾浓度 (mmol/L) 的中位数分别为 2.4 (范围：1.9-3.1)、137 (100-180) 和 17 (8-40)。结肠和盲肠的最大直径 (中位数) 分别为 10.2cm 和 10.5cm。14 例患者中有 5 例单独接受保守治疗有效。中位补钾量为 124mEq/d (40-300)。结肠减压在 6 例患者中有 3 例有效，1 例接受全结肠切除术，14 例患者中有 3 例死亡。SD-CPO 与 C-CPO 的主要区别在于治疗反应较低：保守治疗 (35.7% vs 73.6%，P=.01)、新斯的明 (17% vs 89.2%，P<.001) 和结肠减压 (50% vs 82.4%，P=.02)。
SD-CPO 是一种罕见的表型，与粪便钾增加有关，比 C-CPO 更难治疗。
