Introduction
It is a rare condition with symptoms similar to intestinal obstruction, but no blockage is noticed in the intestines. In intestinal pseudo-obstruction, the nerve or muscles issue slow down or stop the movement of food, air, fluids, and waste through the intestines.
What Are Intestines?
The intestines are part of the digestive tract responsible for absorbing water and nutrients from digested food.
Small Intestine - It includes three parts, duodenum, jejunum, and ileum. Most of the nutrient absorption takes place in the small intestine.
Large Intestine - It includes the cecum, appendix, colon, and rectum. It absorbs water from digested food and converts it into a solid stool.
What Are the Causes of Intestinal Pseudo-Obstruction?
It occurs when the movement of food, fluids, air, and waste is stopped through the intestines due to nerve or muscle problems. The cause of intestinal pseudo-obstruction, depending on its type, are:
Chronic Intestinal Pseudo-Obstruction - Depending on the cause of the disorder, it is classified as primary or secondary.
Primary Chronic Intestinal Pseudo-Obstruction - It is most common in children. The associated cause can be genes if the illness begins in the first year of life. In the cases of adults, the cause is unknown. However, in some cases of chronic intestinal pseudo-obstruction, there can be nerve or muscle problems in other parts of the digestive system, such as the stomach, esophagus, and rarely in the urinary tract.
Secondary Chronic Intestinal Pseudo-Obstruction - Is more common in adults. A large number of health problems can cause secondary chronic intestinal pseudo-obstruction, such as:
Diseases and disorders of nerves like Parkinson’s disease and diabetic neuropathy.
Parkinson’s Disease - A movement disorder due to dopamine deficiency in brain production. The common symptoms include trembling of limbs, jaw, or face, and poor coordination.
Diabetic Neuropathy - Damage of nerves due to diabetes. Symptoms can be pain and numbness in feet or functional issues in internal organs like the bladder and heart—disorders of muscles or connective tissue, such as lupus, scleroderma, and muscular dystrophy.
Lupus - It is an autoimmune disease affecting several body parts like kidneys, joints, skin, lungs, heart, blood vessels, and brain.
Scleroderma - A group of diseases causing abnormal connective tissue growth leading to hard skin. There can be calcium deposits in the connective tissue. Muscular dystrophy is characterized as a group of more than 30 inherited disorders, all causing muscle loss, and muscle weakness. Health issues that can affect metabolisms, such as electrolyte imbalance and porphyria.
Electrolyte Imbalance - Electrolytes are minerals present in body fluids such as sodium, potassium, chloride, and magnesium. Any problem such as dehydration can lead to deficiency and imbalance of these minerals in the body.
Porphyrias - A rare inherited disorder of the skin or nervous system. The affected cells fail to convert chemicals porphyrins and their precursor into heme (the substance responsible for the red color of blood).
Viral infections like herpes or Epstein-Barr virus can damage the nerves supplying the intestine.
Endocrine disorders like hypothyroidism and diabetes.
Hypothyroidism - Deficiency of thyroid hormones in the body due to their less production. The symptoms include weight gain, fatigue, and joint and muscle pain.
Diabetes - Increase in the blood glucose levels due to lack of sufficient insulin production in the pancreas.
Some other diseases include Crohn’s disease, celiac disease, or cancer.
Crohn’s Disease - It is a disease that can cause inflammation and irritation in the digestive tract. The common symptoms are cramps, diarrhea, abdominal pain, and weight loss.
Celiac Disease - Chronic immune and digestive disorder which affects the small intestine. The consumption of gluten-rich foods triggers it.
Some medicines such as antidepressants and opiates.
Antidepressants - Drugs used to treat depression, anxiety, chronic pain, and insomnia.
Opiates - A class of drugs naturally present in opium poppy plants and used to relieve moderate to severe pain.
Radiation therapy is used as a treatment option for cancer.
Acute Colonic Pseudo-Obstruction-
The health issues causing acute colonic obstruction are:
1. The most common cause is a severe illness, recent surgery, or any injury.
2. Heart disorders, such as heart attack, stroke, or heart failure.
- Heart Attack - Also known as myocardial infarction. A condition when blood flow to the heart suddenly gets blocked. The common symptoms are shortness of breath, chest discomfort, and pain in the arms or shoulders.
- Stroke - Also known as a brain attack. When there is a shortage of blood flow to the brain, it leads to oxygen and nutrient deficiency.
3. Physical trauma such as hip or back injury.
4. Disorders affecting metabolisms, such as liver failure, kidney failure, or electrolyte imbalances.
5. Cancer in the spine region from where the nerves connect with the intestines.
6.Surgeries such as organ transplantation, joint replacement, and heart surgery.
What Are the Symptoms of Intestinal Pseudo-Obstruction?
The general symptoms include:
-
Bloating - Feeling of fullness in the abdomen.
-
Abdominal pain.
-
Nausea - A consistent feeling of vomiting and uneasiness.
-
Vomiting - Forceful throwing up of food in the stomach.
-
Diarrhea - Passing loose, watery stools three or more times a day.
-
Constipation- Less than three bowel movements in a week with hard, dry, and lumpy stools.
Nature of Symptoms According to the Type of Intestinal Pseudo-Obstruction-
-
Chronic Intestinal Pseudo-Obstruction - It causes symptoms after meals, which may be long-lasting or for a shorter duration. If the chronic intestinal pseudo-obstruction affects other parts of the digestive system outside the intestines, it causes additional symptoms such as difficulty in swallowing in cases of esophageal infection.
-
Acute Colonic Pseudo-Obstruction - All the symptoms stated above can be observed, along with the inability to pass stool or gas.
How to Diagnose Intestinal Pseudo-Obstruction?
-
Medical History and Physical Examination - The first and most important step in diagnosis is a medical history and physical examination, which includes palpation for checking bloating or abdominal pain.
-
Imaging Tests - Includes X-rays, computed tomography, magnetic resonance imaging (MRI), and upper or lower gastrointestinal series.
-
Endoscopy - Two types of endoscopy, upper gastrointestinal endoscopy, and colonoscopy, can be performed to rule out the presence of obstruction.
-
Manometry Tests - These tests evaluate muscle pressure and movements inside the digestive tract.
-
Scintigraphy Tests - This test involves the consumption of a small dose of a radioactive substance along with meals, which is then tracked by an external camera as it passes through the digestive tract.
-
Gastric Emptying Breath Test - The speed of stomach emptying is evaluated by collecting breath samples after a few hours of food consumption.
What Is the Treatment for Intestinal Pseudo-Obstruction?
Chronic Intestinal Pseudo-Obstruction- This condition can be treated with medicines, nutritional support, decompression, or surgery.
1. Medicines:
-
Laxatives - Drugs such as Psyllium or Docusate are prescribed for passing food through the digestive system quickly.
-
Medicines like Ondansetron are advised to control nausea and vomiting.
-
Antibiotics can be advised to prevent small intestinal bacterial overgrowth.
-
Pain-relieving drugs can be advised to regulate abdominal pain. Opium-based drugs should be avoided as they can worsen pseudo-obstruction.
2. Nutritional Support - Patients may suffer from malnutrition and weight loss due to impaired digestion. To prevent this, diet changes can be advised. In electrolyte imbalance and severe fluid loss, enteral and parenteral nutrition can be given. Food is transferred to the stomach or intestine through a direct tube via the nose in enteral nutrition. Whereas in parenteral nutrition, intravenously minerals and nutrients are administered.
3. Decompression - Remove gas and fluids from the gastrointestinal tract to relieve pressure and discomfort due to pseudo-obstruction. A tube is inserted through the nose into the stomach, and a colonoscopy is performed.
4.Surgery - In some severe cases, a surgical option is considered. The surgeries which can be performed are:
-
Ileostomy or Colostomy - Changing the food route through the intestine in the ileum region.
-
Gastrostomy or Jejunostomy- In this surgery, a tube is placed from outside the body through the abdominal wall, directly reaching the stomach or small intestine. This tube can be used for enteral nutrition and decompression.
-
Bowel Resection - Removal of a small segment of the intestine affected by pseudo- obstruction.
-
Intestinal Transplant- Intestinal transplant is done in severe cases where the patient is recommended parenteral nutrition but can not opt for one.
-
Acute Colonic Pseudo-Obstruction - This condition is generally treated by a conservative approach which includes:
-
Avoid any medication that could worsen the pseudo-obstruction, especially opioids.
-
Preventing the consumption of food or drink directly may stop the movement of food through the intestine.
-
Administration of intravenous fluids and electrolytes.
-
Decompression of digestive tract.
If the acute pseudo-obstruction does not improve within 2-3 days with a conservative approach, the doctor can advise other treatment options listed below:
-
Medications for laxation and relieving pseudo-obstruction.
-
Colonoscopy for decompression.
-
Surgical intervention in cases of damaged colon, especially perforation.
Conclusion
Intestinal pseudo-obstruction is a rare condition that resembles intestinal obstruction, but there is no actual blockage. The symptoms include abdominal pain and difficulty with air, fluids, and waste from the intestines. It can be of two types, chronic intestinal pseudo-obstruction, and acute colonic pseudo-obstruction. The treatment for disease depends on the type of pseudo-obstruction and the nature of symptoms. However, the disease should not be left untreated as it can worsen and cause severe problems such as malnutrition, intestinal perforation, and other infections.
