Di Nardo Giovanni, Zenzeri Letizia, Guarino Matteo, Molfino Alessio, Parisi Pasquale, Barbara Giovanni, Stanghellini Vincenzo, De Giorgio Roberto
NESMOS Department, Faculty of Medicine & Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.
Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Expert Rev Gastroenterol Hepatol. 2023 Apr;17(4):325-341. doi: 10.1080/17474124.2023.2193887. Epub 2023 Mar 26.
Chronic intestinal pseudoobstruction (CIPO) is a rare, heterogenous, and severe form of gastrointestinal dysmotility.
Pertinent literature on pediatric and adult CIPO management has been assessed via PubMed, Scopus, and EMBASE from inception to June 2022. Prokinetics, aimed at restoring intestinal propulsion (e.g. orthopramides and substituted benzamides, acetyl cholinesterase inhibitors, serotonergic agents, and others), have been poorly tested and the available data showed only partial efficacy. Moreover, some prokinetic agents (e.g. orthopramides and substituted benzamides) can cause major side effects. CIPO-related small intestinal bacterial overgrowth requires treatment preferably via poorly absorbable antibiotics to avoid bacterial resistance. Apart from opioids, which worsen gut motility, analgesics should be considered to manage visceral pain, which might dominate the clinical manifestations. Nutritional support, via modified oral feeding, enteral, or parenteral nutrition, is key to halting CIPO-related malnutrition.
There have been significant roadblocks preventing the development of CIPO treatment. Nonetheless, the considerable advancement in neurogastroenterology and pharmacological agents cast hopes to test the actual efficacy of new prokinetics via well-designed clinical trials. Adequate dietary strategies and supplementation remain of crucial importance. Taken together, novel pharmacological and nutritional options are expected to provide adequate treatments forthese patients.
慢性肠道假性梗阻（CIPO）是一种罕见的、异质性的严重胃肠动力障碍形式。
通过PubMed、Scopus和EMBASE检索了从创刊至2022年6月有关儿童和成人CIPO管理的相关文献。旨在恢复肠道推进力的促动力药（如胃复安和取代苯甲酰胺、乙酰胆碱酯酶抑制剂、5-羟色胺能药物等）的试验较少，现有数据仅显示部分疗效。此外，一些促动力药（如胃复安和取代苯甲酰胺）可引起严重副作用。CIPO相关的小肠细菌过度生长最好通过难吸收的抗生素进行治疗，以避免细菌耐药性。除了会加重胃肠动力的阿片类药物外，应考虑使用镇痛药来处理可能主导临床表现的内脏疼痛。通过改良口服喂养、肠内或肠外营养提供营养支持，是阻止CIPO相关营养不良的关键。
CIPO治疗的发展存在重大障碍。尽管如此，神经胃肠病学和药物制剂的显著进展带来了通过精心设计的临床试验来测试新型促动力药实际疗效的希望。适当的饮食策略和补充剂仍然至关重要。综合来看，新型药物和营养选择有望为这些患者提供充分的治疗。
