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Pyridostigmine improves feeding tolerance in pediatric intestinal pseudo-obstruction: A single-center analysis

Teresa Capriati1, Roberto De Giorgio2, Fabrizio Chiusolo3

  • 1Gastroenterology and Nutritional Rehabilitation, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.

Journal of Pediatric Gastroenterology and Nutrition
|August 4, 2025
PubMed

Insights

Pyridostigmine improved enteral nutrition tolerance and reduced parenteral nutrition dependence in pediatric intestinal pseudo-obstruction (PIPO) patients. This treatment also enhanced growth and decreased hospitalizations, offering a promising option for PIPO management.

Area of Science:

  • Pediatric Gastroenterology
  • Gastrointestinal Motility Disorders
  • Clinical Nutrition

Background:

  • Pediatric intestinal pseudo-obstruction (PIPO) encompasses severe dysmotility disorders with significant mortality and morbidity.
  • Current management strategies, including nutritional support, have limitations, highlighting unmet clinical needs.
  • Prokinetic agents may improve oral feeding (OF) and enteral nutrition (EN) tolerance, reducing reliance on parenteral nutrition (PN).

Purpose of the Study:

  • To evaluate the efficacy of pyridostigmine in improving nutritional outcomes and clinical status in pediatric patients with intestinal pseudo-obstruction.
  • To assess changes in enteral nutrition (EN) and parenteral nutrition (PN) dependence, growth parameters, and clinical events following pyridostigmine treatment.

Main Methods:

  • A cohort of 10 pediatric patients intolerant to EN/OF within six months were treated with pyridostigmine.
  • Nutritional outcomes (caloric intake via EN/OF and PN, growth) were assessed at baseline and after 6 and 12 months.
  • Clinical outcomes, including hospitalizations and infections, were compared for 12 months before and after treatment.

Main Results:

  • Pyridostigmine significantly increased EN/OF tolerance, with median caloric intake by EN/OF increasing by over 25% at 12 months (p=0.0156).
  • Two patients were completely weaned off PN, and all patients showed improved growth (median weight z-score increased from -1.3 to -0.9).
  • Hospitalizations and central line-associated bloodstream infections decreased in the year post-treatment; one patient experienced bradycardia.

Conclusions:

  • Pyridostigmine effectively supports nutritional management in PIPO by enhancing EN/OF tolerance and reducing PN dependence.
  • The findings suggest pyridostigmine is a viable therapeutic option for improving outcomes in pediatric intestinal pseudo-obstruction.
  • Further clinical trials are warranted to confirm these preliminary findings in larger PIPO cohorts.
Abstract

Keywords:
artificial nutritionenteral nutrition (EN)intestinal failure (IF)nutritional disordersparenteral nutrition (PN)

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