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Mistakes in chronic intestinal pseudo-obstruction

Carolina Malagelada, Luis Gerardo Alcala Gonzalez

Summary

AI Generated

This article addresses common mistakes in the diagnosis and management of chronic intestinal pseudo-obstruction, a severe condition where the intestines fail to propel contents due to disordered smooth muscle and nerve coordination.

  • Chronic intestinal pseudo-obstruction is a severe condition resulting from disorders in gastrointestinal smooth muscle and nerve function coordination, leading to failure of intestinal propulsion.
  • Management of chronic intestinal pseudo-obstruction involves improving intestinal motility, maintaining nutrition, treating complications, managing exacerbations, and carefully considering invasive procedures.
  • The material focuses on common diagnostic and management mistakes in chronic intestinal pseudo-obstruction, drawing on evidence-based insights and clinical experience.
  • Clinicians managing patients with chronic intestinal pseudo-obstruction or suspected motility disorders would benefit from this content.
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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Gallego D, Malagelada C, Accarino A, et al. Functional neuromuscular impairment in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13458. [Link]
2.
Rosen R, Garza JM, Tipnis N, et al. An ANMS-NASPGHAN consensus document on esophageal and antroduodenal manometry in children. Neurogastroenterol Motil 2018; 30: e13239. [Link]
3.
Stanghellini V, Cogliandro RF, De Giorgio R, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2005; 3: 449–458. [Link]
4.
Keller J, Bassotti G, Clarke J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308. [Link]
5.
Ang D, Pannemans J, Vanuytsel T, et al. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry. Neurogastroenterol Motil 2018; 30: e13357. [Link]
6.
Alcalá-González LG, Malagelada C, Monrroy H, et al. Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction. Neurogastroenterol Motil 2023; 35: e14462. [Link]
7.
Alcala-Gonzalez LG, Malagelada C, Galan C, et al. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 2021; 33: e14240. [Link]
8.
de Jonge CS, Smout AJPM, Nederveen AJ, et al. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30: e13257. [Link]
9.
Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49: 499–517. [Link]
10.
Ohkubo H, Kessoku T, Fuyuki A, et al. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI. Am J Gastroenterol 2013; 108: 1130–1139. [Link]
11.
Menys A, Butt S, Emmanuel A, et al. Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls. Neurogastroenterol Motil 2016; 28: 376–383. [Link]
12.
Alcalá-González LG, Accarino A, Martí R, et al. Distinctive gastrointestinal motor dysfunction in patients with MNGIE. Neurogastroenterol Motil 2023; 35: e14643. [Link]
13.
Alcalá González LG, Malagelada C. Current insights on chronic intestinal dysmotility: pseudo-obstruction and enteric dysmotility. Rev Esp Enferm Dig 2024; 116: 63–67. [Link]
14.
Di Nardo G, Zenzeri L, Guarino M, et al. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17: 325–341. [Link]
15.
Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36: e14715. [Link]
16.
Bianco F, Lattanzio G, Lorenzini L, et al. Enteric Neuromyopathies: Highlights on Genetic Mechanisms Underlying Chronic Intestinal Pseudo-Obstruction. Biomolecules 2022; 12: 1849. [Link]
17.
Hahn JW, Moon SY, Kim MS, et al. ACTG2 Variants in Pediatric Chronic Intestinal Pseudo-obstruction With Megacystis. J Neurogastroenterol Motil 2022; 28: 104–110. [Link]
18.
Bianco F, Bonora E, Lattanzio G, et al. Clinical and Pathological Features of Severe Gut Dysmotility. Adv Exp Med Biol 2022; 1383: 9–17. [Link]
19.
D’Angelo R, Boschetti E, Amore G, et al. Liver transplantation in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): clinical long-term follow-up and pathogenic implications. J Neurol 2020; 267: 3702–3710. [Link]
20.
Stanghellini V, Cogliandro RF, de Giorgio R, et al. Chronic intestinal pseudo-obstruction: manifestations, natural history and management. Neurogastroenterol Motil 2007; 19: 440–452. [Link]
21.
Knowles CH, Veress B, Tornblom H, et al. Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biospy. Neurogastroenterol Motil 2008; 20: 774–779. [Link]
22.
Malagelada C, Karunaratne TB, Accarino A, et al. Comparison between small bowel manometric patterns and full-thickness biopsy histopathology in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13219. [Link]
23.
De Giorgio R, Bianco F, Latorre R, et al. Enteric neuropathies: Yesterday, Today and Tomorrow. Adv Exp Med Biol 2016; 891: 123–133. [Link]
24.
De Giorgio R, Barbara G, Stanghellini V, et al. Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 2002; 97: 2454–2459. [Link]
25.
Rossi S, Merli E, Rinaldi R, et al. Paraneoplastic vs. non-paraneoplastic anti-Hu associated dysmotility: a case series and literature review. J Neurol 2022; 269: 1182–1194. [Link]
26.
Di Nardo G, Di Lorenzo C, Lauro A, et al. Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options. Neurogastroenterol Motil 2017; 29: e12945. [Link]
27.
Radocchia G, Neroni B, Marazzato M, et al. Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota? Microorganisms 2021; 9: 2549. [Link]
28.
Bor S, Kalkan İH, Savarino E, et al. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36: e14774. [Link]
29.
Ohkubo H, Fuyuki A, Arimoto J, et al. Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO). Neurogastroenterol Motil 2017; 29: e13127. [Link]
30.
Mann SD, Debinski HS, Kamm MA. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 1997; 41: 675–681. [Link]
31.
Emmanuel AV, Shand AG, Kamm MA. Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response. Aliment Pharmacol Ther 2004; 19: 687–694. [Link]
32.
O’Dea CJ, Brookes JH, Wattchow DA. The efficacy of treatment of patients with severe constipation or recurrent pseudo-obstruction with pyridostigmine. Colorectal Dis Off J Assoc Coloproctology G B Irel 2010; 12: 540–548. [Link]
33.
Sabbagh C, Amiot A, Maggiori L, et al. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25: e680-686. [Link]
34.
Sogawa H, Costa G, Armanyous S, et al. Twenty Years of Gut Transplantation for Chronic Intestinal Pseudo-obstruction: Technical Innovation, Long-term Outcome, Quality of Life, and Disease Recurrence. Ann Surg 2021; 273: 325–333. [Link]

Abstract

The coordination of smooth muscle and nerve function in the gastrointestinal tract is crucial for digestion and waste disposal. Disorders in this process can lead to chronic intestinal pseudo-obstruction (CIPO), a severe condition where the intestines fail to propel contents. Managing CIPO involves improving intestinal motility, maintaining nutrition, treating complications, managing exacerbations, and carefully considering invasive procedures. This article focuses on common mistakes in CIPO diagnosis and management, offering evidence-based insights and clinical experience.

Topics

Neurogastroenterology & Motility

Citation

Malagelada C and Alcalá-González LG. Mistakes in chronic intestinal pseudo obstruction and how to avoid them. UEG Education 2024; 24: 12-17.

Published

2024

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in ostomy management and how to avoid them

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Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Gallego D, Malagelada C, Accarino A, et al. Functional neuromuscular impairment in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13458. [Link]
2.
Rosen R, Garza JM, Tipnis N, et al. An ANMS-NASPGHAN consensus document on esophageal and antroduodenal manometry in children. Neurogastroenterol Motil 2018; 30: e13239. [Link]
3.
Stanghellini V, Cogliandro RF, De Giorgio R, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2005; 3: 449–458. [Link]
4.
Keller J, Bassotti G, Clarke J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308. [Link]
5.
Ang D, Pannemans J, Vanuytsel T, et al. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry. Neurogastroenterol Motil 2018; 30: e13357. [Link]
6.
Alcalá-González LG, Malagelada C, Monrroy H, et al. Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction. Neurogastroenterol Motil 2023; 35: e14462. [Link]
7.
Alcala-Gonzalez LG, Malagelada C, Galan C, et al. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 2021; 33: e14240. [Link]
8.
de Jonge CS, Smout AJPM, Nederveen AJ, et al. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30: e13257. [Link]
9.
Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49: 499–517. [Link]
10.
Ohkubo H, Kessoku T, Fuyuki A, et al. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI. Am J Gastroenterol 2013; 108: 1130–1139. [Link]
11.
Menys A, Butt S, Emmanuel A, et al. Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls. Neurogastroenterol Motil 2016; 28: 376–383. [Link]
12.
Alcalá-González LG, Accarino A, Martí R, et al. Distinctive gastrointestinal motor dysfunction in patients with MNGIE. Neurogastroenterol Motil 2023; 35: e14643. [Link]
13.
Alcalá González LG, Malagelada C. Current insights on chronic intestinal dysmotility: pseudo-obstruction and enteric dysmotility. Rev Esp Enferm Dig 2024; 116: 63–67. [Link]
14.
Di Nardo G, Zenzeri L, Guarino M, et al. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17: 325–341. [Link]
15.
Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36: e14715. [Link]
16.
Bianco F, Lattanzio G, Lorenzini L, et al. Enteric Neuromyopathies: Highlights on Genetic Mechanisms Underlying Chronic Intestinal Pseudo-Obstruction. Biomolecules 2022; 12: 1849. [Link]
17.
Hahn JW, Moon SY, Kim MS, et al. ACTG2 Variants in Pediatric Chronic Intestinal Pseudo-obstruction With Megacystis. J Neurogastroenterol Motil 2022; 28: 104–110. [Link]
18.
Bianco F, Bonora E, Lattanzio G, et al. Clinical and Pathological Features of Severe Gut Dysmotility. Adv Exp Med Biol 2022; 1383: 9–17. [Link]
19.
D’Angelo R, Boschetti E, Amore G, et al. Liver transplantation in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): clinical long-term follow-up and pathogenic implications. J Neurol 2020; 267: 3702–3710. [Link]
20.
Stanghellini V, Cogliandro RF, de Giorgio R, et al. Chronic intestinal pseudo-obstruction: manifestations, natural history and management. Neurogastroenterol Motil 2007; 19: 440–452. [Link]
21.
Knowles CH, Veress B, Tornblom H, et al. Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biospy. Neurogastroenterol Motil 2008; 20: 774–779. [Link]
22.
Malagelada C, Karunaratne TB, Accarino A, et al. Comparison between small bowel manometric patterns and full-thickness biopsy histopathology in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13219. [Link]
23.
De Giorgio R, Bianco F, Latorre R, et al. Enteric neuropathies: Yesterday, Today and Tomorrow. Adv Exp Med Biol 2016; 891: 123–133. [Link]
24.
De Giorgio R, Barbara G, Stanghellini V, et al. Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 2002; 97: 2454–2459. [Link]
25.
Rossi S, Merli E, Rinaldi R, et al. Paraneoplastic vs. non-paraneoplastic anti-Hu associated dysmotility: a case series and literature review. J Neurol 2022; 269: 1182–1194. [Link]
26.
Di Nardo G, Di Lorenzo C, Lauro A, et al. Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options. Neurogastroenterol Motil 2017; 29: e12945. [Link]
27.
Radocchia G, Neroni B, Marazzato M, et al. Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota? Microorganisms 2021; 9: 2549. [Link]
28.
Bor S, Kalkan İH, Savarino E, et al. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36: e14774. [Link]
29.
Ohkubo H, Fuyuki A, Arimoto J, et al. Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO). Neurogastroenterol Motil 2017; 29: e13127. [Link]
30.
Mann SD, Debinski HS, Kamm MA. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 1997; 41: 675–681. [Link]
31.
Emmanuel AV, Shand AG, Kamm MA. Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response. Aliment Pharmacol Ther 2004; 19: 687–694. [Link]
32.
O’Dea CJ, Brookes JH, Wattchow DA. The efficacy of treatment of patients with severe constipation or recurrent pseudo-obstruction with pyridostigmine. Colorectal Dis Off J Assoc Coloproctology G B Irel 2010; 12: 540–548. [Link]
33.
Sabbagh C, Amiot A, Maggiori L, et al. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25: e680-686. [Link]
34.
Sogawa H, Costa G, Armanyous S, et al. Twenty Years of Gut Transplantation for Chronic Intestinal Pseudo-obstruction: Technical Innovation, Long-term Outcome, Quality of Life, and Disease Recurrence. Ann Surg 2021; 273: 325–333. [Link]

Abstract

Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Topics

Primary Care

Published

2025

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in therapeutic drug monitoring of biologics in IBD and how to avoid them

Adam Cheifetz, Konstantinos Papamichail

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Gallego D, Malagelada C, Accarino A, et al. Functional neuromuscular impairment in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13458. [Link]
2.
Rosen R, Garza JM, Tipnis N, et al. An ANMS-NASPGHAN consensus document on esophageal and antroduodenal manometry in children. Neurogastroenterol Motil 2018; 30: e13239. [Link]
3.
Stanghellini V, Cogliandro RF, De Giorgio R, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2005; 3: 449–458. [Link]
4.
Keller J, Bassotti G, Clarke J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308. [Link]
5.
Ang D, Pannemans J, Vanuytsel T, et al. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry. Neurogastroenterol Motil 2018; 30: e13357. [Link]
6.
Alcalá-González LG, Malagelada C, Monrroy H, et al. Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction. Neurogastroenterol Motil 2023; 35: e14462. [Link]
7.
Alcala-Gonzalez LG, Malagelada C, Galan C, et al. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 2021; 33: e14240. [Link]
8.
de Jonge CS, Smout AJPM, Nederveen AJ, et al. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30: e13257. [Link]
9.
Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49: 499–517. [Link]
10.
Ohkubo H, Kessoku T, Fuyuki A, et al. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI. Am J Gastroenterol 2013; 108: 1130–1139. [Link]
11.
Menys A, Butt S, Emmanuel A, et al. Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls. Neurogastroenterol Motil 2016; 28: 376–383. [Link]
12.
Alcalá-González LG, Accarino A, Martí R, et al. Distinctive gastrointestinal motor dysfunction in patients with MNGIE. Neurogastroenterol Motil 2023; 35: e14643. [Link]
13.
Alcalá González LG, Malagelada C. Current insights on chronic intestinal dysmotility: pseudo-obstruction and enteric dysmotility. Rev Esp Enferm Dig 2024; 116: 63–67. [Link]
14.
Di Nardo G, Zenzeri L, Guarino M, et al. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17: 325–341. [Link]
15.
Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36: e14715. [Link]
16.
Bianco F, Lattanzio G, Lorenzini L, et al. Enteric Neuromyopathies: Highlights on Genetic Mechanisms Underlying Chronic Intestinal Pseudo-Obstruction. Biomolecules 2022; 12: 1849. [Link]
17.
Hahn JW, Moon SY, Kim MS, et al. ACTG2 Variants in Pediatric Chronic Intestinal Pseudo-obstruction With Megacystis. J Neurogastroenterol Motil 2022; 28: 104–110. [Link]
18.
Bianco F, Bonora E, Lattanzio G, et al. Clinical and Pathological Features of Severe Gut Dysmotility. Adv Exp Med Biol 2022; 1383: 9–17. [Link]
19.
D’Angelo R, Boschetti E, Amore G, et al. Liver transplantation in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): clinical long-term follow-up and pathogenic implications. J Neurol 2020; 267: 3702–3710. [Link]
20.
Stanghellini V, Cogliandro RF, de Giorgio R, et al. Chronic intestinal pseudo-obstruction: manifestations, natural history and management. Neurogastroenterol Motil 2007; 19: 440–452. [Link]
21.
Knowles CH, Veress B, Tornblom H, et al. Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biospy. Neurogastroenterol Motil 2008; 20: 774–779. [Link]
22.
Malagelada C, Karunaratne TB, Accarino A, et al. Comparison between small bowel manometric patterns and full-thickness biopsy histopathology in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13219. [Link]
23.
De Giorgio R, Bianco F, Latorre R, et al. Enteric neuropathies: Yesterday, Today and Tomorrow. Adv Exp Med Biol 2016; 891: 123–133. [Link]
24.
De Giorgio R, Barbara G, Stanghellini V, et al. Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 2002; 97: 2454–2459. [Link]
25.
Rossi S, Merli E, Rinaldi R, et al. Paraneoplastic vs. non-paraneoplastic anti-Hu associated dysmotility: a case series and literature review. J Neurol 2022; 269: 1182–1194. [Link]
26.
Di Nardo G, Di Lorenzo C, Lauro A, et al. Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options. Neurogastroenterol Motil 2017; 29: e12945. [Link]
27.
Radocchia G, Neroni B, Marazzato M, et al. Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota? Microorganisms 2021; 9: 2549. [Link]
28.
Bor S, Kalkan İH, Savarino E, et al. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36: e14774. [Link]
29.
Ohkubo H, Fuyuki A, Arimoto J, et al. Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO). Neurogastroenterol Motil 2017; 29: e13127. [Link]
30.
Mann SD, Debinski HS, Kamm MA. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 1997; 41: 675–681. [Link]
31.
Emmanuel AV, Shand AG, Kamm MA. Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response. Aliment Pharmacol Ther 2004; 19: 687–694. [Link]
32.
O’Dea CJ, Brookes JH, Wattchow DA. The efficacy of treatment of patients with severe constipation or recurrent pseudo-obstruction with pyridostigmine. Colorectal Dis Off J Assoc Coloproctology G B Irel 2010; 12: 540–548. [Link]
33.
Sabbagh C, Amiot A, Maggiori L, et al. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25: e680-686. [Link]
34.
Sogawa H, Costa G, Armanyous S, et al. Twenty Years of Gut Transplantation for Chronic Intestinal Pseudo-obstruction: Technical Innovation, Long-term Outcome, Quality of Life, and Disease Recurrence. Ann Surg 2021; 273: 325–333. [Link]

Abstract

Biological therapy has revolutionised the treatment of moderate to severe inflammatory bowel disease (IBD), namely Crohn’s disease (CD) and ulcerative colitis (UC). However, up to one-third of patients with IBD are primary non-responders, and up to half can lose response over time.These unwanted outcomes can be explained by either pharmacodynamic (mechanistic failure) or pharmacokinetic (PK) issues with or without the development of anti-drug antibodies (ADA), so-called immunogenicity.1 Reactive therapeutic drug monitoring (TDM), defined as the measurement of drug concentrations and anti-drug antibody (ADA) levels in the setting of primary non-response (PNR) or secondary loss of response (SLR), can help to explain better and manage these unwanted outcomes. However, it would make sense to try to prevent PNR and SLR by routinely measuring drug concentrations and ADA to achieve and maintain a targeted therapeutic drug concentration, the so-called proactive TDM. Here we discuss some common mistakes and significant errors to avoid when utilising TDM of biologics in patients with IBD. The discussion is based on evidence, whenever possible, and our clinical experience and perception of the field.

Topics

IBD

Citation

Konstantinos Papamichail and Adam S. Cheifetz. Mistakes in therapeutic drug monitoring of biologics in IBD and how to avoid them. UEG Education 2023; 23: 13-18.

Published

2023

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UEG Mistakes In Articles
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Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Gallego D, Malagelada C, Accarino A, et al. Functional neuromuscular impairment in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13458. [Link]
2.
Rosen R, Garza JM, Tipnis N, et al. An ANMS-NASPGHAN consensus document on esophageal and antroduodenal manometry in children. Neurogastroenterol Motil 2018; 30: e13239. [Link]
3.
Stanghellini V, Cogliandro RF, De Giorgio R, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2005; 3: 449–458. [Link]
4.
Keller J, Bassotti G, Clarke J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308. [Link]
5.
Ang D, Pannemans J, Vanuytsel T, et al. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry. Neurogastroenterol Motil 2018; 30: e13357. [Link]
6.
Alcalá-González LG, Malagelada C, Monrroy H, et al. Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction. Neurogastroenterol Motil 2023; 35: e14462. [Link]
7.
Alcala-Gonzalez LG, Malagelada C, Galan C, et al. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 2021; 33: e14240. [Link]
8.
de Jonge CS, Smout AJPM, Nederveen AJ, et al. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30: e13257. [Link]
9.
Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49: 499–517. [Link]
10.
Ohkubo H, Kessoku T, Fuyuki A, et al. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI. Am J Gastroenterol 2013; 108: 1130–1139. [Link]
11.
Menys A, Butt S, Emmanuel A, et al. Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls. Neurogastroenterol Motil 2016; 28: 376–383. [Link]
12.
Alcalá-González LG, Accarino A, Martí R, et al. Distinctive gastrointestinal motor dysfunction in patients with MNGIE. Neurogastroenterol Motil 2023; 35: e14643. [Link]
13.
Alcalá González LG, Malagelada C. Current insights on chronic intestinal dysmotility: pseudo-obstruction and enteric dysmotility. Rev Esp Enferm Dig 2024; 116: 63–67. [Link]
14.
Di Nardo G, Zenzeri L, Guarino M, et al. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17: 325–341. [Link]
15.
Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36: e14715. [Link]
16.
Bianco F, Lattanzio G, Lorenzini L, et al. Enteric Neuromyopathies: Highlights on Genetic Mechanisms Underlying Chronic Intestinal Pseudo-Obstruction. Biomolecules 2022; 12: 1849. [Link]
17.
Hahn JW, Moon SY, Kim MS, et al. ACTG2 Variants in Pediatric Chronic Intestinal Pseudo-obstruction With Megacystis. J Neurogastroenterol Motil 2022; 28: 104–110. [Link]
18.
Bianco F, Bonora E, Lattanzio G, et al. Clinical and Pathological Features of Severe Gut Dysmotility. Adv Exp Med Biol 2022; 1383: 9–17. [Link]
19.
D’Angelo R, Boschetti E, Amore G, et al. Liver transplantation in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): clinical long-term follow-up and pathogenic implications. J Neurol 2020; 267: 3702–3710. [Link]
20.
Stanghellini V, Cogliandro RF, de Giorgio R, et al. Chronic intestinal pseudo-obstruction: manifestations, natural history and management. Neurogastroenterol Motil 2007; 19: 440–452. [Link]
21.
Knowles CH, Veress B, Tornblom H, et al. Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biospy. Neurogastroenterol Motil 2008; 20: 774–779. [Link]
22.
Malagelada C, Karunaratne TB, Accarino A, et al. Comparison between small bowel manometric patterns and full-thickness biopsy histopathology in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13219. [Link]
23.
De Giorgio R, Bianco F, Latorre R, et al. Enteric neuropathies: Yesterday, Today and Tomorrow. Adv Exp Med Biol 2016; 891: 123–133. [Link]
24.
De Giorgio R, Barbara G, Stanghellini V, et al. Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 2002; 97: 2454–2459. [Link]
25.
Rossi S, Merli E, Rinaldi R, et al. Paraneoplastic vs. non-paraneoplastic anti-Hu associated dysmotility: a case series and literature review. J Neurol 2022; 269: 1182–1194. [Link]
26.
Di Nardo G, Di Lorenzo C, Lauro A, et al. Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options. Neurogastroenterol Motil 2017; 29: e12945. [Link]
27.
Radocchia G, Neroni B, Marazzato M, et al. Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota? Microorganisms 2021; 9: 2549. [Link]
28.
Bor S, Kalkan İH, Savarino E, et al. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36: e14774. [Link]
29.
Ohkubo H, Fuyuki A, Arimoto J, et al. Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO). Neurogastroenterol Motil 2017; 29: e13127. [Link]
30.
Mann SD, Debinski HS, Kamm MA. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 1997; 41: 675–681. [Link]
31.
Emmanuel AV, Shand AG, Kamm MA. Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response. Aliment Pharmacol Ther 2004; 19: 687–694. [Link]
32.
O’Dea CJ, Brookes JH, Wattchow DA. The efficacy of treatment of patients with severe constipation or recurrent pseudo-obstruction with pyridostigmine. Colorectal Dis Off J Assoc Coloproctology G B Irel 2010; 12: 540–548. [Link]
33.
Sabbagh C, Amiot A, Maggiori L, et al. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25: e680-686. [Link]
34.
Sogawa H, Costa G, Armanyous S, et al. Twenty Years of Gut Transplantation for Chronic Intestinal Pseudo-obstruction: Technical Innovation, Long-term Outcome, Quality of Life, and Disease Recurrence. Ann Surg 2021; 273: 325–333. [Link]

Abstract

Malnutrition frequently occurs in patients who have chronic liver disease and worsens their prognosis. There are multiple causes of malnutrition in the context of cirrhosis: low dietary intake, malabsorption, metabolic alterations and modification of substrate utilisation. Sarcopenia, which is defined by loss of muscle mass and function, is a major component of malnutrition in patients with cirrhosis. Sarcopenia adversely affects the number and severity of complications, quality of life, the outcome of liver transplantation and the overall survival rate of patients with advanced liver disease. Physicians should be aware of the clinical and prognostic relevance of nutritional status, how to promptly recognise malnutrition and sarcopenia in patients with liver cirrhosis and how to appropriately manage these conditions. Here we discuss some mistakes that are frequently made regarding nutrition in chronic liver disease, and we provide evidence and experience-based approaches to avoid them. 


Topics

Hepatobiliary Small Intestine & Nutrition

Citation

Merli M and Lapenna L. Mistakes in nutrition in chronic liver disease and how to avoid them. UEG Education 2021; 21: 23–25 

Published

2021

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UEG Podcast Episode
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From Vienna to Berlin: What inspired us last year at UEG Week

Egle Dieninyte - Misiune, Pradeep Mundre

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Abstract

Published

2025

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UEG Podcast Episode
New
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What's new in Rome V? Part 1 with Maura Corsetti

Maura Corsetti, Pradeep Mundre

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Abstract

Topics

Neurogastroenterology & Motility

Published

2026

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UEG Mistakes In Articles
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Mistakes in transitional care for children and young adults and how to avoid them

Patrizia Burra, Hans Törnblom, Jorge Amil Dias, Moriam Mustapha

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8
1.
Gallego D, Malagelada C, Accarino A, et al. Functional neuromuscular impairment in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13458. [Link]
2.
Rosen R, Garza JM, Tipnis N, et al. An ANMS-NASPGHAN consensus document on esophageal and antroduodenal manometry in children. Neurogastroenterol Motil 2018; 30: e13239. [Link]
3.
Stanghellini V, Cogliandro RF, De Giorgio R, et al. Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: a single center study. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2005; 3: 449–458. [Link]
4.
Keller J, Bassotti G, Clarke J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 2018; 15: 291–308. [Link]
5.
Ang D, Pannemans J, Vanuytsel T, et al. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry. Neurogastroenterol Motil 2018; 30: e13357. [Link]
6.
Alcalá-González LG, Malagelada C, Monrroy H, et al. Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction. Neurogastroenterol Motil 2023; 35: e14462. [Link]
7.
Alcala-Gonzalez LG, Malagelada C, Galan C, et al. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 2021; 33: e14240. [Link]
8.
de Jonge CS, Smout AJPM, Nederveen AJ, et al. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30: e13257. [Link]
9.
Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49: 499–517. [Link]
10.
Ohkubo H, Kessoku T, Fuyuki A, et al. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI. Am J Gastroenterol 2013; 108: 1130–1139. [Link]
11.
Menys A, Butt S, Emmanuel A, et al. Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls. Neurogastroenterol Motil 2016; 28: 376–383. [Link]
12.
Alcalá-González LG, Accarino A, Martí R, et al. Distinctive gastrointestinal motor dysfunction in patients with MNGIE. Neurogastroenterol Motil 2023; 35: e14643. [Link]
13.
Alcalá González LG, Malagelada C. Current insights on chronic intestinal dysmotility: pseudo-obstruction and enteric dysmotility. Rev Esp Enferm Dig 2024; 116: 63–67. [Link]
14.
Di Nardo G, Zenzeri L, Guarino M, et al. Pharmacological and nutritional therapy of children and adults with chronic intestinal pseudo-obstruction. Expert Rev Gastroenterol Hepatol 2023; 17: 325–341. [Link]
15.
Basilisco G, Marchi M, Coletta M. Chronic intestinal pseudo-obstruction in adults: A practical guide to identify patient subgroups that are suitable for more specific treatments. Neurogastroenterol Motil 2024; 36: e14715. [Link]
16.
Bianco F, Lattanzio G, Lorenzini L, et al. Enteric Neuromyopathies: Highlights on Genetic Mechanisms Underlying Chronic Intestinal Pseudo-Obstruction. Biomolecules 2022; 12: 1849. [Link]
17.
Hahn JW, Moon SY, Kim MS, et al. ACTG2 Variants in Pediatric Chronic Intestinal Pseudo-obstruction With Megacystis. J Neurogastroenterol Motil 2022; 28: 104–110. [Link]
18.
Bianco F, Bonora E, Lattanzio G, et al. Clinical and Pathological Features of Severe Gut Dysmotility. Adv Exp Med Biol 2022; 1383: 9–17. [Link]
19.
D’Angelo R, Boschetti E, Amore G, et al. Liver transplantation in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): clinical long-term follow-up and pathogenic implications. J Neurol 2020; 267: 3702–3710. [Link]
20.
Stanghellini V, Cogliandro RF, de Giorgio R, et al. Chronic intestinal pseudo-obstruction: manifestations, natural history and management. Neurogastroenterol Motil 2007; 19: 440–452. [Link]
21.
Knowles CH, Veress B, Tornblom H, et al. Safety and diagnostic yield of laparoscopically assisted full-thickness bowel biospy. Neurogastroenterol Motil 2008; 20: 774–779. [Link]
22.
Malagelada C, Karunaratne TB, Accarino A, et al. Comparison between small bowel manometric patterns and full-thickness biopsy histopathology in severe intestinal dysmotility. Neurogastroenterol Motil 2018; 30: e13219. [Link]
23.
De Giorgio R, Bianco F, Latorre R, et al. Enteric neuropathies: Yesterday, Today and Tomorrow. Adv Exp Med Biol 2016; 891: 123–133. [Link]
24.
De Giorgio R, Barbara G, Stanghellini V, et al. Clinical and morphofunctional features of idiopathic myenteric ganglionitis underlying severe intestinal motor dysfunction: a study of three cases. Am J Gastroenterol 2002; 97: 2454–2459. [Link]
25.
Rossi S, Merli E, Rinaldi R, et al. Paraneoplastic vs. non-paraneoplastic anti-Hu associated dysmotility: a case series and literature review. J Neurol 2022; 269: 1182–1194. [Link]
26.
Di Nardo G, Di Lorenzo C, Lauro A, et al. Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options. Neurogastroenterol Motil 2017; 29: e12945. [Link]
27.
Radocchia G, Neroni B, Marazzato M, et al. Chronic Intestinal Pseudo-Obstruction: Is There a Connection with Gut Microbiota? Microorganisms 2021; 9: 2549. [Link]
28.
Bor S, Kalkan İH, Savarino E, et al. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36: e14774. [Link]
29.
Ohkubo H, Fuyuki A, Arimoto J, et al. Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO). Neurogastroenterol Motil 2017; 29: e13127. [Link]
30.
Mann SD, Debinski HS, Kamm MA. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Gut 1997; 41: 675–681. [Link]
31.
Emmanuel AV, Shand AG, Kamm MA. Erythromycin for the treatment of chronic intestinal pseudo-obstruction: description of six cases with a positive response. Aliment Pharmacol Ther 2004; 19: 687–694. [Link]
32.
O’Dea CJ, Brookes JH, Wattchow DA. The efficacy of treatment of patients with severe constipation or recurrent pseudo-obstruction with pyridostigmine. Colorectal Dis Off J Assoc Coloproctology G B Irel 2010; 12: 540–548. [Link]
33.
Sabbagh C, Amiot A, Maggiori L, et al. Non-transplantation surgical approach for chronic intestinal pseudo-obstruction: analysis of 63 adult consecutive cases. Neurogastroenterol Motil 2013; 25: e680-686. [Link]
34.
Sogawa H, Costa G, Armanyous S, et al. Twenty Years of Gut Transplantation for Chronic Intestinal Pseudo-obstruction: Technical Innovation, Long-term Outcome, Quality of Life, and Disease Recurrence. Ann Surg 2021; 273: 325–333. [Link]

Abstract

Children and adolescents with chronic diseases requiring lifelong care face unique challenges that affect their daily lives and those of their families. Initially, these patients receive specialized care in pediatric facilities, where parents play a key role in treatment decisions. However, transitioning to adult healthcare facilities is inevitable, and this process, recognized as crucial years ago, involves moving adolescents with chronic conditions from child-centered to adult-oriented care. This transition can be complicated by varying age limits for pediatric care and the scarcity of adult care centers with specific expertise. The transition often requires cooperation between different centers or even countries due to patient mobility. The transition phase is critical, as it can lead to loss of follow-up, treatment suspension, and increased risks of complications or disease relapse. Beyond medical management, various factors influence the long-term prognosis of chronic conditions, making a well-organized transition program essential. While many hospitals have implemented transition models with mixed results in satisfaction, disease control, and follow-up adherence, there are frequent shortcomings in the process. This Mistakes In article will outline eight common mistakes made during the transition from pediatric to adult care, supported by literature and professional experience.

Topics

Primary Care

Citation

Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra. Mistakes in transitional care for children and young adults and how to avoid them. UEG Education 2023; 23: 22-25.

Published

2023

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