Opinion statement
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Acute pseudo-obstruction may manifest clinically in one of three forms—acute gastroparesis, ileus, and acute colonic pseudo-obstruction (Ogilvie’s syndrome). Though formerly associated primarily with the postoperative state, these entities are increasingly recognized in association with a wide variety of major medical problems.
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There are few controlled studies to guide the clinician in the management of these disorders. Treatment remains largely empirical, and time-honored, based primarily on “bowel rest,” nasogastric decompression, and supportive care. While a wide variety of pharmacologic approaches have been advocated, few have been subjected to, or survived, the rigors of a properly controlled trial. Neostigmine is a notable exception, and has been shown to be effective in Ogilvie’s syndrome.
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Perforation is a significant threat in megacolon; colonoscopic, or surgical decompression may, therefore, be indicated. Both are associated with significant risks in this context, but may prevent progression to perforation with its attendant mortality.
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New approaches seek to exploit current concepts in the pathophysiology of ileus and megacolon but have not, as yet, achieved efficacy in human studies.
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Quigley, E.M. Acute intestinal pseudo-obstruction. Curr Treat Options Gastro 3, 273–285 (2000). https://doi.org/10.1007/s11938-000-0041-8
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DOI: https://doi.org/10.1007/s11938-000-0041-8