PDF icon PDF herunterladen
Z Gastroenterol 2002; 40(2): 85-87
DOI: 10.1055/s-2002-20211
Übersicht
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Die chronische intestinale Pseudoobstruktion: Pathogenese, Diagnostik und Therapie

Chronic intestinal pseudoobstruction: Pathogenesis, diagnosis and therapyJ. Keller, P. Layer
  • 1Israelitisches Krankenhaus
Weitere Informationen

Publikationsverlauf

23.1.2001

9.7.2001

Publikationsdatum:
20. Februar 2002 (online)

Auch verfügbar aufeRef
   Lizenzen und Reprints
Preview

Zusammenfassung

Die chronische intestinale Pseudoobstruktion (CIPO) ist ein seltenes Krankheitsbild, bei dem eine schwere intestinale Motilitätsstörung zur Behinderung des Chymustransports bis zum Vollbild eines mechanischen Ileus führt, ohne dass ein Passagehindernis vorliegt. Eine CIPO kann als primäre Erkrankung oder sekundär auftreten aufgrund muskulärer Erkrankungen, neurologischer, metabolischer und endokriner Störungen, aber auch postinfektiös, postoperativ, nach abdomineller Bestrahlung, durch Medikamente oder Noxen. Beim Vollbild ist die typische Anamnese mit frustranen Laparotomien unter dem Verdacht eines mechanischen Ileus diagnostisch wegweisend. Bei Verdacht auf eine CIPO muss mithilfe radiologischer und endoskopischer Verfahren sorgfältig nach einem mechanischen Hindernis gesucht werden. Aussagekräftige histologische Untersuchungen sind i. d. R. nur an transmuralen Darmwandbiopsien möglich. Mittels Dünndarmmanometrie kann die Diagnose einer CIPO auch im Intervall gesichert und zwischen Neuropathie und Myopathie unterschieden werden. Primäre Therapieziele sind: 1. Die Aufrechterhaltung eines adäquaten Ernährungszustandes durch orale und/oder enterale Ernährung; bei schweren Verlaufsformen kommt eine heimparenterale Ernährung und insbesondere bei Kindern als Ultima Ratio die Dünndarmtransplantation infrage. 2. Die Wiederherstellung einer intestinalen Propulsion durch Prokinetika. 3. Die Behandlung von Komplikationen wie bakterielle Fehlbesiedlung und ausgeprägte Schmerzen durch Antibiotika bzw. gezielte chirurgische Eingriffe. Unnötige Operationen sollten unbedingt vermieden werden, da sie das klinische Bild durch Bridenbildung wesentlich komplizieren können.

Abstract

Chronic intestinal pseudoobstruction (CIPO) is a rare disease in which a severe intestinal motility disorder impairs transit of chyme so that patients suffer from symptoms of a mechanical ileus without mechanical obstruction. CIPO may be a primary or secondary disorder due to muscular, neurologic, metabolic or endocrine disorders, but may also occur postinfectiously, postoperatively, following abdominal radiation or be caused by drugs or noxae. In severe cases, the typical history of (repeated) symptoms of mechanical obstruction leading to unsuccessful laparotomies will give key clues for diagnosis. If CIPO is suspected, mechanical obstruction must be searched for carefully by radiologic and endoscopic examinations. Histologic diagnosis usually demands full thickness biopsies of the intestinal wall. Small intestinal manometry allows diagnosis of CIPO even during oligosymptomatic intervals as well as differentiation among neuropathic and myopathic forms of the disease. The main therapeutic goals consist in: 1. Maintenance of an adequate nutritional state by oral and/or enteral nutrition; in severe cases home-parenteral nutrition may be required and particularly in children intestinal transplantation may be the ultima ratio. 2. Reconstitution of intestinal propulsion by prokinetic drugs. 3. Therapy of complications such as bacterial overgrowth and severe pain by antibiotics and specific surgical procedures. Unnecessary laparotomies should be strictly avoided because they may lead to adhesions and markedly complicate the clinical course.

Schlüsselwörter fehlen

Schlüsselwörter fehlen

Key words fehlen

Key words fehlen

5. Literaturverzeichnis

  • 1 Faure C, Goulet O, Ategbo S. et al . Chronic intestinal pseudoobstruction syndrome: Clinical analysis, outcome, and prognosis in 105 children. French-Speaking Group of Pediatric Gastroenterology.  Dig Dis Sci. 1999;  44 953-959
    Suche in Google Scholar
  • 2 Patel R, Christensen J. Chronic intestinal pseudo-obstruction: Diagnosis and treatment.  Gastroenterologist. 1995;  3 345-356
    Suche in Google Scholar
  • 3 Auricchio A, Brancolini V, Casari G. et al . The locus for a novel syndromic form of neuronal intestinal pseudoobstruction maps to Xq28.  Am J Hum Genet. 1996;  58 743-748
    Suche in Google Scholar
  • 4 FitzPatrick D R, Strain L, Thomas A E. et al . Neurogenic chronic idiopathic intestinal pseudo-obstruction, patent ductus arteriosus, and thrombocytopenia segregating as an X linked recessive disorder.  J Med Genet. 1997;  34 666-669
    Suche in Google Scholar
  • 5 Malagelada J R, Distrutti E. Management of gastrointestinal motility disorders. A practical guide to drug selection and appropriate ancillary measures.  Drugs. 1996;  52 494-506
    Suche in Google Scholar
  • 6 Mitros F A, Schuffler M D, Teja K, Anuras S. Pathologic features of familial visceral myopathy.  Hum Pathol. 1982;  13 825-833
    Suche in Google Scholar
  • 7 Shimotake T, Iwai N, Yanagihara J, Tokiwa K, Fushiki S. Biliary tract complications in patients with hypoganglionosis and chronic idiopathic intestinal pseudoobstruction syndrome.  J Pediatr Surg. 1993;  28 189-192
    Suche in Google Scholar
  • 8 Forchielli M L, Young M C, Flores A F, Richardson D, Lo C W. Immune deficiencies in chronic intestinal pseudo-obstruction.  Acta Paediatr. 1997;  86 1077-1081
    Suche in Google Scholar
  • 9 Husebye E. The patterns of small bowel motility: Physiology and implications in organic disease and functional disorders.  Neurogastroenterol Motil. 1999;  11 141-161
    Suche in Google Scholar
  • 10 DiMagno E P, Hendricks J C, Go V L, Dozois R R. Relationships among canine fasting pancreatic and biliary secretions, pancreatic duct pressure, and duodenal phase III motor activity - Boldyreff (n??) revisited.  Dig Dis Sci. 1979;  24 689-693
    Suche in Google Scholar
  • 11 Keller J, Groeger G, Cherian L, Günther B, Layer P. Circadian coupling between pancreatic secretion and intestinal motility in humans.  Am J Physiol. 2001; in press; 
    Suche in Google Scholar
  • 12 Layer P, Chan A T, Go V L, DiMagno E P. Human pancreatic secretion during phase II antral motility of the interdigestive cycle.  Am J Physiol. 1988;  254 G249-G253
    Suche in Google Scholar
  • 13 von der nnn O, Layer P, Wollny C. et al . Somatostatin 28 and coupling of human interdigestive intestinal motility and pancreatic secretion.  Gastroenterology. 1992;  103 974-981
    Suche in Google Scholar
  • 14 Layer P, Chan A T, Go V L, Zinsmeister A R, DiMagno E P. Cholinergic regulation of phase II interdigestive pancreatic secretion in humans.  Pancreas. 1993;  8 181-188
    Suche in Google Scholar
  • 15 Layer P H, Chan A T, Go V L, Zinsmeister A R, DiMagno E P. Adrenergic modulation of interdigestive pancreatic secretion in humans.  Gastroenterology. 1992;  103 990-993
    Suche in Google Scholar
  • 16 Vantrappen G, Janssens J, Hellemans J, Ghoos Y. The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine.  J Clin Invest. 1977;  59 1158-1166
    Suche in Google Scholar
  • 17 Husebye E, Skar V, Hoverstad T, Iversen T, Melby K. Abnormal intestinal motor patterns explain enteric colonization with gram-negative bacilli in late radiation enteropathy.  Gastroenterology. 1995;  109 1078-1089
    Suche in Google Scholar
  • 18 Khurana R K, Schuster M M. Autonomic dysfunction in chronic intestinal pseudo-obstruction.  Clin Auton Res. 1998;  8 335-340
    Suche in Google Scholar
  • 19 Camilleri M, Balm R K, Low P A. Autonomic dysfunction in patients with chronic intestinal pseudo-obstruction.  Clin Auton Res. 1993;  3 95-100
    Suche in Google Scholar
  • 20 Camilleri M, Carbone L D, Schuffler M D. Familial enteric neuropathy with pseudoobstruction.  Dig Dis Sci. 1991;  36 1168-1171
    Suche in Google Scholar
  • 21 Verne G N, Sninsky C A. Chronic intestinal pseudo-obstruction.  Dig Dis. 1995;  13 163-181
    Suche in Google Scholar
  • 22 Vanderwinden J M, Rumessen J J. Interstitial cells of Cajal in human gut and gastrointestinal disease.  Microsc Res Tech. 1999;  47 344-360
    Suche in Google Scholar
  • 23 Yamataka A, Ohshiro K, Kobayashi H. et al . Abnormal distribution of intestinal pacemaker (C-KIT-positive) cells in an infant with chronic idiopathic intestinal pseudoobstruction.  J Pediatr Surg. 1998;  33 859-862
    Suche in Google Scholar
  • 24 Wang Z Q, Watanabe Y, Toki A. et al . Involvement of endogenous nitric oxide and c-kit-expressing cells in chronic intestinal pseudo-obstruction.  J Pediatr Surg. 2000;  35 539-544
    Suche in Google Scholar
  • 25 Sarna S K. Cyclic motor activity; migrating motor complex: 1985 (nnn??).  Gastroenterology. 1985;  89 894-913
    Suche in Google Scholar
  • 26 Matulis S R, McJunkin B, Chang H H. Familial visceral neuropathy as part of a diffuse neuronal syndrome: Four fatal cases in one sibship.  Am J Gastroenterol. 1994;  89 792-796
    Suche in Google Scholar
  • 27 Fell J M, Smith V V, Milla P J. Infantile chronic idiopathic intestinal pseudo-obstruction: The role of small intestinal manometry as a diagnostic tool and prognostic indicator.  Gut. 1996;  39 306-311
    Suche in Google Scholar
  • 28 Coulie B, Camilleri M. Intestinal pseudo-obstruction.  Annu Rev Med. 1999;  50 37-55
    Suche in Google Scholar
  • 29 Koppelman R N, Stollman N H, Baigorri F, Rogers A I. Acute small bowel pseudo-obstruction due to AL amyloidosis: A case report and literature review.  Am J Gastroenterol. 2000;  95 294-296
    Suche in Google Scholar
  • 30 Sigurdsson L, Reyes J, Kocoshis S A. et al . Intestinal transplantation in children with chronic intestinal pseudo-obstruction [see comments].  Gut. 1999;  45 570-574
    Suche in Google Scholar
  • 31 Cucchiara S, Borrelli O, Salvia G. et al . A normal gastrointestinal motility excludes chronic intestinal pseudoobstruction in children.  Dig Dis Sci. 2000;  45 258-264
    Suche in Google Scholar
  • 32 Mann S D, Debinski H S, Kamm M A. Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults.  Gut. 1997;  41 675-681
    Suche in Google Scholar
  • 33 Stanghellini V, Camilleri M, Malagelada J R. Chronic idiopathic intestinal pseudo-obstruction: Clinical and intestinal manometric findings.  Gut. 1987;  28 5-12
    Suche in Google Scholar
  • 34 Faber J, Fich A, Steinberg A. et al . Familial intestinal pseudoobstruction dominated by a progressive neurologic disease at a young age.  Gastroenterology. 1987;  92 786-790
    Suche in Google Scholar
  • 35 Chakravarti A, Blanton S, Kendall B J, McCallum R W. Cosegregation of familial intestinal pseudoobstruction and presence of digital arches in a large multigenerational pedigree.  Dig Dis Sci. 1996;  41 1429-1433
    Suche in Google Scholar
  • 36 Byrne W J, Cipel L, Ament M E, Gyepes M T. Chronic idiopathic intestinal pseudo-obstruction syndrome. Radiologic signs in children with emphasis on differentiation from mechanical obstruction.  Diagn Imaging. 1981;  50 294-304
    Suche in Google Scholar
  • 37 Luks F I, Chung M A, Brandt M L. et al . Pneumatosis and pneumoperitoneum in chronic idiopathic intestinal pseudoobstruction.  J Pediatr Surg. 1991;  26 1384-1386
    Suche in Google Scholar
  • 38 Barnett J L, McDonnell W M, Appelman H D, Dobbins W O. Familial visceral neuropathy with neuronal intranuclear inclusions: Diagnosis by rectal biopsy.  Gastroenterology. 1992;  102 684-691
    Suche in Google Scholar
  • 39 Borczuk A, Mannion C, Dickson D, Alt E. Intestinal pseudo-obstruction and ischemia secondary to both beta 2-microglobulin and serum A amyloid deposition.  Mod Pathol. 1995;  8 577-582
    Suche in Google Scholar
  • 40 Goulet O, Jobert-Giraud A, Michel J L. et al . Chronic intestinal pseudo-obstruction syndrome in pediatric patients.  Eur J Pediatr Surg. 1999;  9 83-89
    Suche in Google Scholar
  • 41 Hanks J B, Meyers W C, Andersen D K. et al . Chronic primary intestinal pseudo-obstruction.  Surgery. 1981;  89 175-182
    Suche in Google Scholar
  • 42 Huang Y C, Lee H C, Huang F Y. et al . Neonatal-onset chronic intestinal pseudo-obstruction syndrome.  Clin Pediatr (Phila). 1995;  34 241-247
    Suche in Google Scholar
  • 43 Bruyn G A, Bots G T, Van Wijhe M, Van Kersen F. Chronic intestinal pseudoobstruction as a possible sequel to encephalitis.  Am J Gastroenterol. 1986;  81 50-54
    Suche in Google Scholar
  • 44 McDonald G B, Schuffler M D, Kadin M E, Tytgat G N. Intestinal pseudoobstruction caused by diffuse lymphoid infiltration of the small intestine.  Gastroenterology. 1985;  89 882-889
    Suche in Google Scholar
  • 45 Arista-Nasr J, Gonzalez-Romo M, Keirns C, Larriva-Sahd J. Diffuse lymphoplasmacytic infiltration of the small intestine with damage to nerve plexus. A cause of intestinal pseudo-obstruction.  Arch Pathol Lab Med. 1993;  117 812-819
    Suche in Google Scholar
  • 46 Hutson J M, Chow C W, Borg J. Intractable constipation with a decrease in substance P-immunoreactive fibres: Is it a variant of intestinal neuronal dysplasia?.  J Pediatr Surg. 1996;  31 580-583
    Suche in Google Scholar
  • 47 Fogel S P, DeTar M W, Shimada H, Chandrasoma P T. Sporadic visceral myopathy with inclusion bodies. A light-microscopic and ultrastructural study.  Am J Surg Pathol. 1993;  17 473-481
    Suche in Google Scholar
  • 48 Arslan M, Bayraktar Y, Oksuzoglu G. et al . Four cases with chronic intestinal pseudo-obstruction due to hollow visceral myopathy.  Hepatogastroenterology. 1999;  46 349-352
    Suche in Google Scholar
  • 49 Ghoos Y F, Maes B D, Geypens B J. et al . Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test.  Gastroenterology. 1993;  104 1640-1647
    Suche in Google Scholar
  • 50 Miller M A, Parkman H P, Urbain J L. et al . Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit: Lactulose accelerates small bowel transit.  Dig Dis Sci. 1997;  42 10-18
    Suche in Google Scholar
  • 51 Cucchiara S, Annese V, Minella R. et al . Antroduodenojejunal manometry in the diagnosis of chronic idiopathic intestinal pseudoobstruction in children.  J Pediatr Gastroenterol Nutr. 1994;  18 294-305
    Suche in Google Scholar
  • 52 Di Lorenzo C, Reddy S N, Flores A F, Hyman P E. Is electrogastrography a substitute for manometric studies in children with functional gastrointestinal disorders?.  Dig Dis Sci. 1997;  42 2310-2316
    Suche in Google Scholar
  • 53 Faure C, Wolff V P, Navarro J. Effect of meal and intravenous erythromycin on manometric and electrogastrographic measurements of gastric motor and electrical activity.  Dig Dis Sci. 2000;  45 525-528
    Suche in Google Scholar
  • 54 Keller J, Ahmadi-Simab K, Ohe M, Rabe B, Layer P. Intestinal manometry: Differentiation of neuropathic motor disorders and additional mechanical obstruction.  Gastroenterology. 1998;  114 A776 (Abstract)
    Suche in Google Scholar
  • 55 Heneyke S, Smith V V, Spitz L, Milla P J. Chronic intestinal pseudo-obstruction: Treatment and long-term follow-up of 44 patients.  Arch Dis Child. 1999;  81 21-27
    Suche in Google Scholar
  • 56 Di Lorenzo C, Flores A F, Buie T, Hyman P E. Intestinal motility and jejunal feeding in children with chronic intestinal pseudo-obstruction.  Gastroenterology. 1995;  108 1379-1385
    Suche in Google Scholar
  • 57 Watanabe Y, Ito T, Ando H, Seo T, Nimura Y. Manometric evaluation of gastrointestinal motility in children with chronic intestinal pseudo-obstruction syndrome.  J Pediatr Surg. 1996;  31 233-238
    Suche in Google Scholar
  • 58 Hyman P E, Di Lorenzo C, McAdams L. et al . Predicting the clinical response to cisapride in children with chronic intestinal pseudo-obstruction [see comments].  Am J Gastroenterol. 1993;  88 832-836
    Suche in Google Scholar
  • 59 Wood J D. Neuropathy in the brain-in-the-gut [In Process Citation].  Eur J Gastroenterol Hepatol. 2000;  12 597-600
    Suche in Google Scholar
  • 60 Mok M Y, Wong R W, Lau C S. Intestinal pseudo-obstruction in systemic lupus erythematosus: An uncommon but important clinical manifestation.  Lupus. 2000;  9 11-18
    Suche in Google Scholar
  • 61 Perlemuter G, Chaussade S, Wechsler B. et al . Chronic intestinal pseudo-obstruction in systemic lupus erythematosus.  Gut. 1998;  43 117-122
    Suche in Google Scholar
  • 62 Lennon V A, Sas D F, Busk M F. et al . Enteric neuronal autoantibodies in pseudoobstruction with small-cell lung carcinoma [see comments].  Gastroenterology. 1991;  100 137-142
    Suche in Google Scholar
  • 63 Gerl A, Storck M, Schalhorn A. et al . Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.  Gut. 1992;  33 1000-1003
    Suche in Google Scholar
  • 64 Scolapio J S, Ukleja A, Bouras E P, Romano M. Nutritional management of chronic intestinal pseudo-obstruction.  J Clin Gastroenterol. 1999;  28 306-312
    Suche in Google Scholar
  • 65 Layer P, Go V L, DiMagno E P. Fate of pancreatic enzymes during small intestinal aboral transit in humans.  Am J Physiol. 1986;  251 G475-G48
    Suche in Google Scholar
  • 66 Levitt M D, Hirsh P, Fetzer C A, Sheahan M, Levine A S. H2 excretion after ingestion of complex carbohydrates.  Gastroenterology. 1987;  92 383-389
    Suche in Google Scholar
  • 67 Stephen A M, Haddad A C, Phillips S F. Passage of carbohydrate into the colon. Direct measurements in humans.  Gastroenterology. 1983;  85 589-595
    Suche in Google Scholar
  • 68 Cavicchi M, Beau P, Crenn P, Degott C, Messing B. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure.  Ann Intern Med. 2000;  132 525-532
    Suche in Google Scholar
  • 69 Carlsson G, Hakansson A, Rubensson A, Finkel Y. Home parenteral nutrition (HPN) in children in Sweden.  Pediatr Nurs. 1997;  23 272-274
    Suche in Google Scholar
  • 70 Moukarzel A A, Haddad I, Ament M E. et al . 230 patient years of experience with home long-term parenteral nutrition in childhood: Natural history and life of central venous catheters.  J Pediatr Surg. 1994;  29 1323-1327
    Suche in Google Scholar
  • 71 Chasco Y A, Guibelalde d C, Moreno V J. et al . Home parenteral nutrition in the management of patients with chronic idiopathic intestinal pseudo-obstruction.  Nutr Hosp. 1995;  10 264-267
    Suche in Google Scholar
  • 72 Vargas J H, Sachs P, Ament M E. Chronic intestinal pseudo-obstruction syndrome in pediatrics. Results of a national survey by members of the North American Society of Pediatric Gastroenterology and Nutrition.  J Pediatr Gastroenterol Nutr. 1988;  7 323-332
    Suche in Google Scholar
  • 73 Di Lorenzo C, Reddy S N, Villanueva-Meyer J. et al . Cisapride in children with chronic intestinal pseudoobstruction. An acute, double-blind, crossover, placebo-controlled trial.  Gastroenterology. 1991;  101 1564-1570
    Suche in Google Scholar
  • 74 Camilleri M, Brown M L, Malagelada J R. Impaired transit of chyme in chronic intestinal pseudoobstruction. Correction by cisapride.  Gastroenterology. 1986;  91 619-626
    Suche in Google Scholar
  • 75 Cohen N P, Booth I W, Parashar K, Corkery J J. Successful management of idiopathic intestinal pseudo-obstruction with cisapride.  J Pediatr Surg. 1988;  23 229-230
    Suche in Google Scholar
  • 76 Fraser A G, Arthur J F, Hamilton I. Intestinal pseudoobstruction secondary to amyloidosis responsive to cisapride.  Dig Dis Sci. 1991;  36 532-535
    Suche in Google Scholar
  • 77 Feighner S D, Tan C P, McKee K K. et al . Receptor for motilin identified in the human gastrointestinal system.  Science. 1999;  284 2184-2188
    Suche in Google Scholar
  • 78 Storr M, Allescher H D. Motilitätsmodifizierende Pharmaka.  Internist. 2000;  41 1318-1330
    Suche in Google Scholar
  • 79 Minami T, Nishibayashi H, Shinomura Y, Matsuzawa Y. Effects of erythromycin in chronic idiopathic intestinal pseudo-obstruction.  J Gastroenterol. 1996;  31 855-859
    Suche in Google Scholar
  • 80 Vassallo M J, Camilleri M, Sullivan S N, Thomforde G M. Effects of erythromycin on gut transit in pseudo-obstruction due to hereditary coproporphyria [see comments].  J Clin Gastroenterol. 1992;  14 255-259
    Suche in Google Scholar
  • 81 Perlemuter G, Cacoub P, Chaussade S. et al . Octreotide treatment of chronic intestinal pseudoobstruction secondary to connective tissue diseases.  Arthritis Rheum. 1999;  42 1545-1549
    Suche in Google Scholar
  • 82 Peracchi M, Basilisco G, Bareggi B. et al . Plasma somatostatin levels in patients with chronic idiopathic intestinal pseudo-obstruction.  Am J Gastroenterol. 1997;  92 1884-1886
    Suche in Google Scholar
  • 83 Haruma K, Wiste J A, Camilleri M. Effect of octreotide on gastrointestinal pressure profiles in health and in functional and organic gastrointestinal disorders.  Gut. 1994;  35 1064-1069
    Suche in Google Scholar
  • 84 Verne G N, Eaker E Y, Hardy E, Sninsky C A. Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction.  Dig Dis Sci. 1995;  40 1892-1901
    Suche in Google Scholar
  • 85 Bouhnik Y, Alain S, Attar A. et al . Bacterial populations contaminating the upper gut in patients with small intestinal bacterial overgrowth syndrome.  Am J Gastroenterol. 1999;  94 1327-1331
    Suche in Google Scholar
  • 86 Layer P, Rosien U. Bakterielle Fehlbesiedlung. Layer P, Rosien U, Goebell H Praktische Gastroenterologie München, Wien, Baltimore; Urban & Schwarzenberg 1996: 225-226
    Suche in Google Scholar
  • 87 Attar A, Flourie B, Rambaud J C. et al . Antibiotic efficacy in small intestinal bacterial overgrowth-related chronic diarrhea: A crossover, randomized trial.  Gastroenterology. 1999;  117 794-797
    Suche in Google Scholar
  • 88 Vanderhoof J A, Young R J, Murray N, Kaufman S S. Treatment strategies for small bowel bacterial overgrowth in short bowel syndrome.  J Pediatr Gastroenterol Nutr. 1998;  27 155-160
    Suche in Google Scholar
  • 89 Rolfe R D. The role of probiotic cultures in the control of gastrointestinal health.  J Nutr. 2000;  130 396S-402S
    Suche in Google Scholar
  • 90 Di Stefano M, Malservisi S, Veneto G, Ferrieri A, Corazza G R. Rifaximin versus chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth.  Aliment Pharmacol Ther. 2000;  14 551-556
    Suche in Google Scholar
  • 91 Trespi E, Ferrieri A. Intestinal bacterial overgrowth during chronic pancreatitis.  Curr Med Res Opin. 1999;  15 47-52
    Suche in Google Scholar
  • 92 Ginies J L, Francois H, Joseph M G. et al . A curable cause of chronic idiopathic intestinal pseudo-obstruction in children: Idiopathic myositis of the small intestine.  J Pediatr Gastroenterol Nutr. 1996;  23 426-429
    Suche in Google Scholar
  • 93 Yokota T, Suda T, Tsukioka S. et al . The striking effect of hyperbaric oxygenation therapy in the management of chronic idiopathic intestinal pseudo-obstruction.  Am J Gastroenterol. 2000;  95 285-288
    Suche in Google Scholar
  • 94 Schuffler M D, Leon S H, Krishnamurthy S. Intestinal pseudoobstruction caused by a new form of visceral neuropathy: Palliation by radical small bowel resection.  Gastroenterology. 1985;  89 1152-1156
    Suche in Google Scholar
  • 95 Mughal M M, Irving M H. Treatment of end stage chronic intestinal pseudo-obstruction by subtotal enterectomy and home parenteral nutrition.  Gut. 1988;  29 1613-1617
    Suche in Google Scholar
  • 96 Murr M M, Sarr M G, Camilleri M. The surgeon’s role in the treatment of chronic intestinal pseudoobstruction.  Am J Gastroenterol. 1995;  90 2147-2151
    Suche in Google Scholar
  • 97 Hase T, Kodama M, Kishida A. et al . The application of radio-opaque markers prior to ileostomy in an infant with chronic intestinal pseudo-obstruction: Report of a case.  Surg Today. 1998;  28 83-86
    Suche in Google Scholar
  • 98 Reyes J, Bueno J, Kocoshis S. et al . Current status of intestinal transplantation in children.  J Pediatr Surg. 1998;  33 243-254
    Suche in Google Scholar
  • 99 Goulet O, Jan D, Lacaille F. et al . Intestinal transplantation in children: Preliminary experience in Paris.  JPEN J Parenter Enteral Nutr. 1999;  23 S121-S125
    Suche in Google Scholar
  • 100 Camilleri M. Study of human gastroduodenojejunal motility. Applied physiology in clinical practice [see comments].  Dig Dis Sci. 1993;  38 785-794
    Suche in Google Scholar

Anschrift für die Verfasser

Dr. J. Keller

Israelitisches Krankenhaus

Orchideenstieg 14

22297 Hamburg