Review of nutrition management of pediatric intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIPO) is a rare, heterogeneous, and debilitating disorder characterized by profound intestinal dysmotility and severe nutrition challenges. Its presentation resembles that of mechanical bowel obstruction, but CIPO occurs in the absence of luminal obstruction. Pediatric-onset CIPO has higher morbidity and mortality and is termed pediatric intestinal pseudo-obstruction (PIPO) to differentiate it from adult-onset CIPO. PIPO often presents with vague abdominal symptoms such as abdominal pain, distension, bloating, constipation, and diarrhea. Nutrition therapy is the mainstay of the management of PIPO. The main management goals include maintaining an adequate caloric intake, avoiding fluid and electrolyte imbalance, minimizing/managing malnutrition, treating gastrointestinal symptoms, enhancing intestinal motility using pharmacological interventions, and managing complications such as small intestinal bacterial overgrowth. Surgical interventions are reserved for severe cases. Various modalities of nutrition intervention include modification of oral diet, enteral feeding, and parenteral nutrition. Most children with PIPO have a poor quality of life, and the prognosis is variable based on the underlying condition. Prognosis is better in an interdisciplinary team setting in specialized centers of excellence.