An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo-obstruction and enteric dysmotility
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- An international survey on clinicians' perspectives on the diagnosis and management of chronic intestinal pseudo-obstruction and enteric dysmotility
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Background: Chronic intestinal pseudo-obstruction (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 among 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 Results: Of 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 <.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. While 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 and Inferences: These data highlight the difficulties with diagnosing and managing CIPO and ED and underscore the urgent need for international, multidisciplinary, clinical practice guidelines.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | e13937 |
| Tidsskrift | Neurogastroenterology and Motility |
| Vol/bind | 32 |
| Udgave nummer | 12 |
| ISSN | 1350-1925 |
| DOI | |
| Status | Udgivet - 2020 |
Bibliografisk note
Funding Information:
No external funding was received for this study. The authors would like to acknowledge the partner societies which supported this study including ESPEN, United European Gastroenterology, ESNM, and the neurogastroenterology and motility section of the BSG. The authors would also like to acknowledge the following participants: Tim Vanuytsel (Belgium), Greger Lindberg (Sweden), Amol Sharma (USA), Christian Hvas (Denmark), Asbjorn Mohr Drewes (Denmark), Magnus Simren (Sweden), Carolina Malagelada (Spain), Mark Fox (Switzerland), Vincenzo Stanghellini (Italy), Jutta Keller (Germany), Per M. Hellstrom (Sweden), Gabrio Bassotti (Italy), Maura Corsetti (UK), Hans Tornblom (Sweden), Lisa Sharkey (UK), Mani Naghibi (UK), Jeremy Nightingale (UK), Konstantine Shemerovskii (Russia), Natalia Zarate-Lopez (UK), Charlotte Pither (UK), Dan M Livovsky (Israel), Fermin Estremera-Arevalo (Spain), Sofia Silva Mendes (Portugal), Yan Yiannakou (UK), Pauline Riviere (France), Sadek Mostafa (Egypt), Usama Hantour (Egypt),Timothy Ambrose (UK), Ashley Bond (UK), Clare Donnellan (UK), Jens F. Dahlerup (Denmark), Giles Major (UK), Peter J Whorwell (UK), Duncan Massey (UK), David Sawbridge (UK), Antje Teubner (UK), Philip Smith (UK), Ramya Kalaiselvan (UK), Peter Mooney (UK), Martyn Dibb (UK), Gemma Wiltshaw (UK), Charlotte Rutter (UK), Klaus Krogh (Denmark), David Armstrong (Canada), Luis Miguel Becerra Granados (Guatemala), Nick Thompson (UK), Jonathan Tyrrell-Price (UK), Michael Glynn (UK), Khalid Sager (UK), Mattias Soop (Sweden), Maria Ines Pinto Sanchez (Canada), Alison Culkin (UK), Stephane M. Schneider (France), Gerard Rafferty (Northern Ireland), Sheldon Cooper (UK), Suzanne C Donnelly (UK), Mia Small (UK), Shaheen Hamdy (UK), Larry Loo (UK), Anna Zmarzay (Poland), Carmen Arraiza (Spain), Anna Demagistris (Italy), Elisabeth De Waele (Belgium), Ingrid Gisbertz (Netherlands), Aurora E Serralde-Ziga (Mexico), Carmelo Loinaz Segurola (Spain), Fernanda Luisa Ceragioli Oliveira (Brazil), Vicente Jose Salles De Abreu (Brazil), Leah Gramlich (Canada), Jose Manuel Moreno Villares (Spain), Kalina Grivcheva Stardelova (Macedonia), Mireille Serlie (Netherlands), Gallitelli Livia (Italy), Paula Ravasco (Portugal), Edda Cava (Italy), Arenas Marquez Humberto (Spain), Gilberto Fabian Hurtado-Torres (Mexico), Donnabelle Navarrete (Philippines), Silcia de Barrio (Argentina), Dechelotte (France), Anders Thorell (Sweden), Leuenberger Michele (Switzerland), Chambrier Cecile (France), Jarosaw Szefel (Poland), Michele Barone (Italy), Adriana Crivelli (Argentina), Fatema Mubarak (Bahrain), Hanna-Liis Lepp (Estonia), H. ne Braet (Belgium), Eduardo Eiras Moreira da Rocha (Brazil), Shestopalov AE (Russia), Inmaculada Moraga Guerrero (Spain), Rinoy Chandran (India), Vaidotas Urbonas (Lithuania), Pascal Probst (Germany), Daniel Lightowler (Australia), Arun Abraham (UK), Asma Fikree (UK), Louise Langmead (UK), Ruth Mckee (UK), Klaartje Kok (UK), Charles Knowles (UK), Taina Sipponen (Finland), Sampsa Pikkarainen (Finland), Colin Ainley (UK), Philip Woodland (UK), Penny Neild (UK), Catherine Fraser (UK), Farooq Rahman (UK), Thomas Bazin (France), Marianna Arvanitakis (Belgium), Yeng Ang (UK), Wadiamu Gashau (UK), Emily Tucker (UK), Maria Luisa Eliana Luisi (Italy), Georgiana- Emmanuela Gilca-Blanariu (Romania), Oana Timofte (Romania), Christopher Calvert (UK), Phil Bliss (UK), Rosa Burgos (Spain), Stephanie Hansel (USA), A N De Silva (UK), Giselle Lopes (Brazil), and Irma Poveda Merlo (Columbia).
Publisher Copyright:
© 2020 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd
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