Manchester University NHS Foundation Trust, Manchester, UK.
University of Manchester, Manchester, UK.
Neurogastroenterol Motil. 2020 Dec;32(12):e13937. doi: 10.1111/nmo.13937. Epub 2020 Jul 22.
Chronic intestinal pseudo-obstruction (CIPO) and enteric dysmotility (ED) are small intestinal motility disorders defined by radiological and manometric criteria. In the absence of consensus guidelines, we surveyed opinions on the diagnosis and management of CIPO and ED among experts from different countries.
A survey questionnaire was circulated electronically to members of the European society for Clinical Nutrition and Metabolism, European Society of Neurogastroenterology and Motility, and United European Gastroenterology. Only responses from participants completing all required components were included.
Of 154 participants, 93% agreed that CIPO and ED should be classified separately. Overall, 73% reported an increasing incidence of CIPO and ED, with hypermobile Ehlers-Danlos Syndrome the group with the largest increase in referrals (37%), particularly in the UK (P < .0001). The majority (95%) find diagnosing CIPO and ED difficult. Notably, antroduodenal manometry, a test mandated to diagnose ED, is infrequently used (only 21% respondents use in >50% cases) and full thickness biopsies were reported to seldom influence medical treatment, nutritional management, and prognosis. Respondents reported that very few treatments are useful for most patients, with bacterial overgrowth treatment, prucalopride, and psychological therapies felt to be the most useful. While only 23% of clinicians felt that parenteral nutrition (PN) improves gastrointestinal symptoms in >50% of cases, 68% reported PN dependency at 5 years in the majority of cases.
These data highlight the difficulties with diagnosing and managing CIPO and ED and underscore the urgent need for international, multidisciplinary, clinical practice guidelines.
慢性肠道假性梗阻（CIPO）和肠动力障碍（ED）是通过影像学和测压标准定义的小肠运动障碍。由于缺乏共识指南，我们调查了来自不同国家的专家对 CIPO 和 ED 的诊断和管理的意见。
电子方式向欧洲临床营养与代谢学会、欧洲神经胃肠病学和动力学会以及联合欧洲胃肠病学会的成员发送了一份调查问卷调查。只有完成所有必需部分的参与者的回复才被包括在内。
在 154 名参与者中，93%的人同意 CIPO 和 ED 应分开分类。总体而言，73%的人报告 CIPO 和 ED 的发病率增加，其中可移动型埃勒斯-当洛斯综合征（EDS）患者的转诊率增幅最大（37%），尤其是在英国（P<.0001）。大多数（95%）人认为诊断 CIPO 和 ED 很困难。值得注意的是，用于诊断 ED 的测压检查（十二指肠-胃测压）很少被使用（仅 21%的受访者在>50%的病例中使用），全层活检很少影响药物治疗、营养管理和预后。受访者报告称，对于大多数患者，很少有治疗方法是有用的，细菌过度生长治疗、普芦卡必利和心理疗法被认为最有用。虽然只有 23%的临床医生认为肠外营养（PN）改善胃肠道症状的比例>50%，但 68%的人报告说在大多数情况下，PN 的依赖性在 5 年内达到。
这些数据突出了诊断和管理 CIPO 和 ED 的困难，并强调了迫切需要制定国际、多学科的临床实践指南。
