Successful Management of Chronic Intestinal Pseudo-Obstruction with Home Parenteral Nutrition

Chronic intestinal pseudo-obstruction is a disorder of gut motility resulting in severe abdominal pain, bloating, nausea, and vomiting after eating. The avoidance of food in order to minimize symptoms causes malnutrition. To date, no medical or surgical treatment has been shown to be of lasting benefit. We treated 10 patients disabled by chronic intestinal pseudo-obstruction using home parenteral nutrition. All were rendered minimally symptomatic as long as they refrained from significant oral intake. Nine of the 10 patients were malnourished prior to the institution of treatment. Home parenteral nutrition increased mean total body weight from 74.7 ± 2.9 to 93.5 ± 3.7% (p < 0.001), mean lean body mass from 78.4 ± 6.5 to a mean of 92.7 ± 2.6 (p < 0.02), and mean body fat from 57.1 ± 8.8 to 83.8 ± 8.2% of expected values (p < 0.05). Mean total body potassium increased from 68.8 ± 13.1 to 80.5 ± 10.7 g (p < 0.05). We conclude that in chronic intestinal pseudo-obstruction, home parenteral nutrition coupled with minimal oral intake effectively relieves symptoms and significantly improves the nutritional depletion. (Journal of Parenteral and Enteral Nutrition 9:173-178, 1985)