What’s New in June for Gastroenterology, Hepatology, and Endoscopy features:
- Chronic Intestinal Pseudo-Obstruction
- Pain in Chronic Pancreatitis
Gastrointestinal tract innervation and related pharmacologic treatments
Laurence Guay, MD
Gastroenterology, Université de Sherbrooke, Sherbrooke, Québec
Braden Kuo, MD, MS
Harvard Medical School, Boston, MA
Chronic Intestinal Pseudo-Obstruction
Chronic intestinal pseudo-obstruction (CIPO) is a little-known form of enteric dysmotility characterized by small bowel transit delay and distention without mechanical obstruction. The most frequently reported symptoms are abdominal distention and pain, but other common symptoms are nausea, vomiting, epigastric pain, early satiety, diarrhea, and constipation. Weight loss, malnutrition, and vitamin depletion can occur later in the course of the disease. Prucalopride, a recently introduced 5-HT4 agonist available in Canada and Europe, has been demonstrated to significantly improve symptoms associated with CIPO, with few reported side effects.
Computer tomographic scan of calcific chronic pancreatitis (arrows).
Darwin L Conwell, MD
Medicine/Gastroenterology, Hepatology, University of Cincinnati, Cincinnati, OH
Veeral M Oza, MD
The Ohio State University Medical Center, Columbus, OH
Pain in Chronic Pancreatitis
The origin of chronic pancreatitis (CP) pain is debated and the mechanisms are unclear, but pain in CP has been recently described as a neurobiologic phenomenon, associated with changes in the brain cortex as well as altered nociception and organ innervations. Two emerging concepts with respect to pain mediation in CP include “mechanical allodynia,” whereby, following previous sensitization of the nociceptive system, pain is sensed even in the absence of stimuli, and “inflammatory hyperalgesia,” in which relatively minor inflammation may trigger increased pain response due to already “primed” pancreatic nociceptors.