Treatment Options for Chronic Intestinal Pseudo-Obstruction
CIP remains a challenge to treat. Therapy for secondary causes of CIP should focus on the underlying disorder. This often includes correcting electrolytes,managing dehydration, treating infections, using immunosuppressants for patients with collagen vascular diseases, initiating a gluten-free diet for pseudo-obstruction associated with celiac disease,or treating the underlying cancer that has caused a paraneoplastic syndrome.
Treating idiopathic or primary CIP, however, is often quite difficult. One important lesson to remember is the adage of primum no nocere. Ill-planned or repeated surgeries, radical treatments, and injudicious use of narcotics will make the patient worse. Although several large, double blind, placebo controlled studies were performed to evaluate the efficacy of medications for the treatment of CIP in the past, these agents are either no longer available (cisapride) or theylack US Food and Drug Administration approval (domperidone). Large, recent, randomized controlled trials are otherwise lacking, and the results of therapy are found only in small studies or individual case reports.