The characterization and management of chronic severe gastrointestinal (GI) dysmotility are challenging.
It may cause intestinal failure requiring home parenteral nutrition (HPN).
Dr Paine and colleagues from the United Kingdom reviewed the presentation, etiology, characterization, management and outcome of chronic severe GI dysmotility, and to suggest a pragmatic management algorithm.
The researchers performed a PubMed search up to 2012 using appropriate search terms, restricted to human articles and reviewed for relevance.
Segmental dysmotility, acute ileus, functional syndromes and non-English articles were excluded.
Evidence and recommendations were evaluated using the GRADE system.
The team reviewed 721 relevant articles.
|Fewer than 20% undergo full thickness jejunal biopsy|
|Alimentary Pharmacology & Therapeutics|
A coherent and definitive picture is hampered by overlapping classification systems using multi-modal characterization methods, subject to pitfalls and some requiring further validation.
The research team observed that the literature is confined to case series with no randomized trials.
The team noted fewer than 20% undergo full thickness jejunal biopsy, which are otherwise labelled idiopathic.
However, in studies with up to 80% biopsy rates, neuromuscular abnormalities may be found in 90%.
The team found that between 14% and 50% will require HPN, comprising 8–14% of all HPN patients, of which 2/3 are primary/idiopathic and 1/3 secondary, with scleroderma being the leading secondary cause.
The team reported that 10-year mortality ranges from 13% to 35%, and is worst in elderly scleroderma patients.
The researchers found that management includes limited treatments for secondary causes, prokinetics, symptom palliation, psychological support, nutrition, hydration and judicious surgery.
Dr Paine's team concludes, "Severe dysmotility often remains idiopathic."
"It is rarely possible to alter disease trajectory, and consequently, prognosis may be poor."
"Multi-disciplinary teams in a specialist setting can improve outcomes."
"Graded recommendations are enumerated and a pragmatic algorithm is suggested."