An international survey on clinicians' perspectives on the diagnosis and management of Chronic Intestinal Pseudoobstruction and Enteric Dysmotility

Dipesh Vasant, Loris Pironi, Giovanni Barbara, Frederico Bozzetti, Cristina Cuerda, Francisca Joly, Manpreet Mundi, Peter Paine, Michael Staun, Kinga Szczepanek, Andre Van Gossum, Geert Wanten, Simon Lal

Research output: Contribution to journalArticlepeer-review

Abstract

Background Chronic intestinal pseudoobstruction (CIPO) and Enteric Dysmotility (ED) are small intestinal motility disorders defined by radiological and manometric criteria. In the absence of consensus guidelines, we surveyed opinions on the diagnosis and management of CIPO and ED amongst experts from different countries.
Methods A survey questionnaire was circulated electronically to members of the European society for Clinical Nutrition and Metabolism, European Society of Neurogastroenterology and Motility, and United European Gastroenterology. Only responses from participants completing all required components were included.
Key ResultsOf 154 participants, 93% agreed that CIPO and ED should be classified separately. Overall, 73% reported an increasing incidence of CIPO and ED, with hypermobile Ehlers-Danlos Syndrome the group with the largest increase in referrals (37%), particularly in the UK (P<0.0001). The majority (95%) find diagnosing CIPO and ED difficult. Notably, antroduodenal manometry, a test mandated to diagnose ED, is infrequently used (only 21% respondents use in >50% cases) and full thickness biopsies were reported to seldom influence medical treatment, nutritional management and prognosis. Respondents reported that very few treatments are useful for most patients, with bacterial overgrowth treatment, prucalopride and psychological therapies felt to be the most useful. Whilst only 23% of clinicians felt that parenteral nutrition (PN) improves gastrointestinal symptoms in >50% of cases, 68% reported PN dependency at 5 years in the majority of cases. 
Conclusions & Inferences These data highlight the difficulties with diagnosing and managing CIPO and ED, and underscore the urgent need for international, multidisciplinary, clinical practice guidelines.
Original languageEnglish
JournalNeurogastroenterology and Motility
Early online date22 Jul 2020
DOIs
Publication statusE-pub ahead of print - 22 Jul 2020

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