Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

852 Intestinal Motor Disorders

differential diagnosis

■Mechanical bowel obstruction (strictures, tumors, adhesions)

management

What to Do First

■Rule out mechanical obstruction by radiologic or endoscopic means

General Measures

■Early institution of enteral nutrition for neuropathic disorders

■Parenteral nutrition may be necessary for patients with severe myo-

pathic pseudo-obstruction

specific therapy

Indications for Treatment

■Nausea, vomiting, constipation and diarrhea require symptomatic

therapy Weight loss requires nutritional support

Treatment Options

■Intermittent courses of antibiotics, such as ciprofloxacin, doxycy-

cline, and metronidazole in patients with small bowel bacterial over-

growth.

■Intravenous erythromycin effective during acute exacerbations

of intestinal pseudo-obstruction, acting as a motilin receptor

stimulant; not very effective as chronic therapy; IV metoclopramide

may also be used during acute exacerbations

■Octreotide partly recovers the migratory motor complex and may

improve motility in patients with scleroderma or idiopathic intesti-

nal pseudo-obstruction

■Neostigmine, an acetylcholinesterase inhibitor, effective acutely but

not for patients with chronic pseudoobstruction

■Serotonin (5HT) receptor agonists currently under investigation.

■Surgical resection of the small bowel or colon or bypass of dilated

intestinal segments may be needed

■Laparoscopy also used to place venting and/or feeding tubes and

to obtain a full-thickness biopsy of the intestinal wall for histologic

examination

■Intestinal pacing and transplantation still experimental

Side Effects and Complications

■Metabolic and electrolyte abnormalities are due to uncontrolled dis-

ease Extrapyramidal signs with metoclopramide administration