The 4th Joint Session between JDDW-KDDW-TDDW1(JDDW)
Thu. November 5th   9:00 - 11:15   Room 9: Portopia Hotel Main Building Kairaku 3
JKT1-RS1
 Research Progress of Chronic Intestinal Pseudo-obstruction (CIPO) in Japan and Future Perspective
Hidenori Ohkubo
Hepatology and Gastroenterology Division, Yokohama City University Hospital
Chronic intestinal pseudo-obstruction (CIPO) is a rare and severe digestive disease characterized by long-term symptoms of intestinal obstruction without any mechanical cause. Sustained increased intra-bowel pressure often causes small intestinal malabsorption and bacterial translocation, which leads to poor clinical outcomes. However, no clear diagnostic criteria had been established so far, and the recognition rate was quite low in Japan. Therefore, in 2012 our Research Group proposed diagnostic criteria for the first time in the world to facilitate the diagnosis of this rare disease by the general physician. The criteria are useful in clinical practice with a high sensitivity of 86.3% in Japanese cases.
In the Western countries, manometry, scintigraphy, and full-thickness biopsy are the major examination for the CIPO diagnosis; however, these examinations are generally invasive or expose the patient to ionizing radiation. Therefore, in 2013, our group developed non-invasive and radiation-free new modality cine-MRI. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO using cine-MRI. As a result, cine-MRI clearly detected the contractility impairment in CIPO patients by video motion.
In 2014, considering these research progress, the Japanese criteria have been revised, and the comprehensive criteria from a child to an adult have been devised. Moreover, in 2015, CIPO is newly certified as Specified Rare and Intractable Disease which is subsidized from public expense in Japan.
Regarding treatment, intestinal decompression plays a key role, but conventional method including a trans-nasal small intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method was urgently desired. In 2017, we conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy in CIPO patients. We found that PEG-J can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. PEG-J has the potential to be a novel decompression therapy for CIPO available at home with a minimum invasion.
Most recently, in 2019, we started an investigator-initiated phase 2 trial, which assesses the efficacy and safety of rifaximin in patients with CIPO. Rifaximin is expected to reduce the small intestinal gas and improve the symptom of abdominal bloating.
In the future, oral antibiotics therapy may become a new non-invasive therapy for patients with this intractable disease.
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