Natural History of Chronic Intestinal Pseudo-obstruction and Need for Palliative Care.

IF 3.3 3区 医学 Q2 CLINICAL NEUROLOGY Journal of Neurogastroenterology and Motility Pub Date : 2023-07-30 DOI:10.5056/jnm22152
Kosuke Tanaka, Hidenori Ohkubo, Atsushi Yamamoto, Kota Takahashi, Yuki Kasai, Anna Ozaki, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Noboru Misawa, Akiko Fuyuki, Shingo Kato, Takuma Higurashi, Kunihiro Hosono, Masato Yoneda, Takeo Kurihashi, Masataka Taguri, Atsushi Nakajima, Kok-Ann Gwee, Takaomi Kessoku
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Abstract

Background/aims: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients.

Methods: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course.

Results: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2, 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care.

Conclusion: CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

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慢性假性肠梗阻的自然史和对姑息治疗的需要。
背景/目的:慢性假性肠梗阻(CIPO)是一种罕见的以非机械性肠梗阻发作为特征的疾病,其在成人中的自然史尚不清楚。本研究评估CIPO的临床病程和患者的姑息治疗需求。方法:从2010年10月至2021年9月,前瞻性纳入74例接受MRI检查并明确诊断为CIPO的患者。我们调查了疾病的病因和结局、发病年龄、会诊时的营养状况(体重指数和血清白蛋白)、氢呼气试验结果和疾病过程中的总肠外营养(TPN)。结果:47例患者(64%)为女性,发病时平均年龄44岁,诊断时平均年龄49岁。48例(65%)患者出现原发性CIPO。继发性CIPO 26例(35%),其中硬皮病18例(69%)。平均体重指数为17 kg/m2,血清白蛋白水平为3.8 mg/dL,氢呼气试验阳性率为60%。分别有23例(31%)和18例(24%)患者需要TPN和有创减压治疗。51例(69%)患者进行了肠道灭菌,33例(65%)患者有效;其中28例(85%)服用甲硝唑。7名(9%)患者使用阿片类药物。死亡9例(12%),其中5例(56%)死于感染,2例(22%)死于自杀。在死亡病例中,分别有6例(67%)和4例(44%)接受了TPN治疗和减压治疗。51名患者(69%)希望接受姑息治疗。结论:CIPO是一种罕见、严重且未被充分认识的疾病。标准化的治疗策略,包括姑息治疗和精神干预,是需要的。
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来源期刊
Journal of Neurogastroenterology and Motility
Journal of Neurogastroenterology and Motility GASTROENTEROLOGY & HEPATOLOGY-CLINICAL NEUROLOGY
CiteScore
6.30
自引率
8.80%
发文量
96
期刊介绍: Journal of Neurogastroenterology and Motility (J Neurogastroenterol Motil) is a joint official journal of the Korean Society of Neurogastroenterology and Motility, the Thai Neurogastroenterology and Motility Society, the Japanese Society of Neurogastroenterology and Motility, the Indian Motility and Functional Disease Association, the Chinese Society of Gastrointestinal Motility, the South East Asia Gastro-Neuro Motility Association, the Taiwan Neurogastroenterology and Motility Society and the Asian Neurogastroenterology and Motility Association, launched in January 2010 after the title change from the Korean Journal of Neurogastroenterology and Motility, published from 1994 to 2009.
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