Regarding CIPO treatment, the use of a single pharmacological agent to treat CIPO patients is rarely effective and usually several tools are required. CIPO can be only managed with symptomatic therapy aimed to reduce symptoms severity, to prevent unnecessary surgery and to improve the nutritional status maintaining an adequate caloric intake, promoting intestinal motility and treating SIBO. Currently, pharmacological therapies used to improve GI dysmotility are prokinetic agents. Erythromycin (macrolide antibiotic), often associated to octreotide, represents a useful option exerting GI prokinetic effects by inducing antrum-duodenal phase III of the migrating motor complex, consequently accelerating the small bowel transit. A group of drugs affecting serotonin (5-hydroxytryptamine or 5-HT) pathway has been tested for CIPO patients’ treatment. In particular, prucalopride is a 5-HT4 receptor agonist with prokinetic properties exerting in accelerating gastric emptying and small-bowel transit. Other agents useful in improvement GI motility are acetyl-cholinesterase inhibitors (ACIs) (neostigmine and pyridostigmine). Their action in increasing GI motility is well described in children and adult with CIPO refractory to standard therapies. However, to date, these drugs are only able to improve management of some symptoms of CIPO. The second crucial point of CIPO management is prevented and treat SIBO mainly using antibiotics. Amoxicillin-clavulanate, ciprofloxacin, doxycycline, and metronidazole are the agents most used to improve abdominal distention and pain in CIPO patients. Nevertheless, the most recent recommended agent is rifaximin, a poorly absorbed antibiotic that, differently to the others, exerts non-traditional effects on the gut microbiota in addiction to bactericidal/bacteriostatic activity, producing lower bacterial resistance than traditional agents. Its administration improves SIBO-associated symptoms and breath test results. Finally, fecal microbiota transplantation (FMT) has been recently proposed as a new therapeutic option for CIPO patients. A pilot study, conducted by Gu and collaborators, demonstrated that FMT significantly improves patients’ conditions, alleviating pain and bloating symptoms, and eliminating SIBO in 71% of patients after only two weeks of treatment.
Author(s) Details:
Giulia Radocchia
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Bruna Neroni
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Massimiliano Marazzato
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Elena Capuzzo
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Simone Zuccari
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Fabrizio Pantanella
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Letizia Zenzeri
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy and Paediatric Emergency Department, Santobono-Pausilipon Children’s Hospital, Naples, Italy
Melania Evangelisti
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Francesca Vassallo
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Pasquale Parisi
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Giovanni Di Nardo
NESMOS Department, Paediatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy.
Serena Schippa
Department of Public Health and Infection Disease, Microbiology Section, Sapienza University of Rome, Italy
Recent Global Research Developments in Advances in CIPO Management and Treatment
Diagnostic Approach:
A stepwise diagnostic approach is crucial for patients with suspected CIPO [1] .
Recent reports suggest promising results in diagnostic testing, aiding accurate diagnosis and patient management.
Treatment Strategies:
Optimizing nutritional status is essential. This includes oral, enteral, and parenteral approaches.
Therapies to improve intestinal motility play a key role.
Endoscopic and surgical management options are also considered [2] .
Subgroups and Future Directions:
CIPO can be classified into subgroups based on underlying causes (e.g., autoimmune/inflammatory forms or congenital forms).
Immunosuppressive treatment may benefit autoimmune/inflammatory cases, while genetic counseling and gene therapy hold promise for congenital forms [3] .
Multidisciplinary Approach:
Treating CIPO requires collaboration among pediatricians, gastroenterologists, dietitians, surgeons, mental health personnel, and other specialists based on comorbidities [4] .
References
- Zenzeri, L., Tambucci, R., Quitadamo, P., Giorgio, V., De Giorgio, R., & Di Nardo, G. (2020). Update on chronic intestinal pseudo-obstruction. Current opinion in gastroenterology, 36(3), 230-237.
- Laique, S.N., Gabbard, S.L. (2019). Chronic Intestinal Pseudo-Obstruction. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_5
- Basilisco, G., Marchi, M., & Coletta, M. (2024). Chronic intestinal pseudo‐obstruction in adults: a practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterology & Motility, 36(1), e14715.
- Connor, F. L., & Di Lorenzo, C. (2006). Chronic intestinal pseudo-obstruction: assessment and management. Gastroenterology, 130(2), S29-S36.
