Acute and Chronic Intestinal Pseudo-Obstruction
In this podcast, Brooks Cash, MD, speaks about the management of patients with acute or chronic intestinal pseudo-obstruction. Dr Cash also spoke on this topic at The American College of Gastroenterology Annual Scientific Meeting 2022 during a lecture titled “In the Belly of the Beast: Acute and Chronic Intestinal Pseudo-Obstruction” as part of the ACG pharmacology course.
This podcast was recorded prior to the ACG Annual Scientific Meeting.
- Cash B. In the belly of the beast: acute and chronic intestinal pseudo-obstruction. Talk presented at: ACG 2022; October 21-26, 2022; Charlotte, NC. Accessed October 12, 2022. https://acgmeetings.gi.org/
Brooks D. Cash, MD, is the division director of Gastroenterology, Hepatology, and Nutrition with McGovern Medical School at UTHealth Houston (Houston, TX).
Jessica Bard Hello everyone, and welcome to another installment of Podcast 360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant 360, a multidisciplinary medical information network. Dr Brooks Cash is here to speak with us today about his session at ACG 2022, titled "In the Belly of the Beast: Acute and Chronic Intestinal Pseudo-Obstruction." Dr Cash is the division director of Gastroenterology, Hepatology, and Nutrition with McGovern Medical School at UTHealth in Houston, Texas. Thank you for joining us today, Dr Cash. Firstly, could you please provide us with an overview of your session?
Dr Brooks Cash: Sure. My lecture is part of a larger course called the ACG Pharmacology Course. It's an extra course during the meeting and during this course, we have a number of experts talk about disease states and conditions in GI that rely on pharmaceutical therapies for their management. One of the things that I'm talking about is, as you mentioned, acute colonic pseudo obstruction.
This is a relatively common condition that we get consulted on primarily in the hospital. It's a condition that is characterized by atony or a lack of motility of the GI tract, primarily the colon, and that leads to a dilation of the colon, which can become very severe and actually can result in perforation or sepsis or infection. This is a condition that occurs in sick patients, so patients who are hospitalized for any number of reasons. Many are postoperative, some may have come in with pneumonia or sepsis or heart attacks or other conditions, but something has pushed them over the edge. They're very ill and for some reason, and we don't know exactly why, although we believe there's an imbalance with regards to the way that the nervous system of the gut is maintained because of the severe illness that these patients have that leads to this dysmotility and this dilation of the colon, which can be life-threatening if not dealt with.
Jessica Bard: Then you also talk about in your session chronic pseudo-obstruction. What do you plan to mention in your session?
Dr Brooks Cash: Yeah, so chronic pseudo-obstruction is not exactly the opposite of that, but it's a much less common condition than acute colonic pseudo-obstruction. Now, I failed to mention with acute colonic pseudo-obstruction, the way that we manage that condition is generally by trying to reverse whatever the underlying illness is that the patient has, but there are some medications that we can use that promote motility of the colon. In my lecture, I go over those medications, how to use them, some investigational therapies that have been looked at, as well. We also talk about the endoscopic management of this condition, in terms of the acute colonic pseudo-obstruction.
For the chronic, this is a much rarer condition, as I mentioned. Usually, we encounter this in the outpatient setting. It's very similar in presentation. These are patients who will have an increasing abdominal girth and bloating, and what we find in these patients is they have huge dilation of their colon and sometimes even their small intestine. It's a rare condition, about one out of a hundred thousand people in terms of prevalence, typically older patients.
I talk in my lecture about different theories as to where this may come from. It's likely a multifactorial condition and it likely has a similar etiology or cause as acute colonic pseudo-obstruction, which is basically a dysfunction of the enteric nervous system such that there's not effective communication from the nerves to the muscles. There may actually be muscular issues in terms of the muscles that line the GI tract that cause it to squeeze and evacuate and push air and contents down towards the bottom for eventual evacuation. There's some sort of an imbalance with that.
In addition to the diagnostic process, we talk about the therapeutic process. We do use some different medications than we use for acute colonic pseudo-obstruction. The issues with chronic is because it's so rare and we don't have very good trials, we don't have any large studies of effective therapies. All the trials that we have are very descriptive. They're very small, really more case series and case reports. But there are some therapies that have been shown to be effective in some patients with chronic intestinal pseudo obstruction, so I talk about those, when to use those, how to use those medications, and then other aspects of trying to care for these patients, as well.
Jessica Bard: What would you say are the key take-home messages from your session?
Dr Brooks Cash: I think the key take-home messages are that for the acute colonic pseudo-obstruction, there are medical therapies available and we should use those in conjunction with our conservative management, making sure the patient's electrolytes are okay, making sure that they're up and ambulating and moving around when possible, and also possibly using those medications in conjunction with endoscopic therapy. The therapeutic approach to acute colonic obstruction is really multifactorial and complimentary. The take-home message from chronic intestinal pseudo-obstruction is understanding how we diagnose this condition and what the possible etiologies are, and then some of the more effective therapies that have been shown in the literature, recognizing that there is a lack of strong evidence to support a lot of those different therapies. But for many clinicians who are not familiar or as familiar with these conditions, they don't know how to treat this or they may be unfamiliar with some of the approaches, and so having some of those options available and educating them about some of those medications that can be effective in these patients is I think the real take-home message for the part about chronic intestinal pseudo-obstruction.
Jessica Bard: Well, thank you Dr Cash. We really appreciate your time. Is there anything else that you'd like to add?
Dr Brooks Cash: No, I just want to thank you for giving me the opportunity to talk about this. These are uncommon conditions and yet especially for the acute colonic pseudo-obstruction, quite important. I think that folks who are able to participate and attend the meeting will hopefully get some useful information that they'll be able to then take home and help their patients, so I appreciate the opportunity to discuss this and promote it.
Jessica Bard: Absolutely. My pleasure. Thank you