Diagnosing pseudo-obstruction

Intestinal pseudo-obstruction is a diagnostic term which encompasses a variety of disorders in which the gut has lost its ability to coordinate muscular activity.

Pseudo-obstruction can be caused by dysfunction in the enteric nervous system (ENS), in gut smooth muscle, or in the nerve systems outside the gut which control ENS. Diseases affecting the ENS are termed visceral neuropathies whereas those affecting visceral muscle are called visceral myopathies.

The aim of the diagnostic work in suspected pseudo-obstruction is to correctly classify the disorder with regard to aetiology and underlying pathology. Both prognostic and therapeutic decision making is facilitated by information about the underlying pathology. The diagnosis of intestinal pseudo-obstruction in the adult rests mainly upon three clinical methods:

Medical history*, analysis of symptoms and history data;
Manometry*, the measurement of contractile activity of the gut; and
Histopathologic investigation* of full thickness biopsy from the gut.

Radiological investigation of the gastrointestinal tract may also yield important diagnostic information, not least for the exclusion of other causes for the symptoms.

One of the problems with the diagnosis of pseudo-obstruction is the boundary against the far more prevalent functional disorders of the gut, i.e. functional dyspepsia and the irritable bowel syndrome. It is unknown whether these are related, and if there exists a clinical entity between the irritable bowel syndrome and pseudo-obstruction.

The most common complication in intestinal pseudo-obstruction is bacterial overgrowth. It is important to look for and to treat this condition which may contribute to both symptoms and malabsorption of nutrients.

General

Diagnosing pseudo-obstruction

Scientific