Hi. I am wondering if anyone can give me some info on testing for CIPO. I have GP and take domperidone but feel I have some sort of motility problem with my bowels. I have been on a liquid diet of ensure, gatorade, and broth for sometime. Recently I had what I call a severe episode....constipation, severe pain and nausea, severe gas, all over flu feeling, pain in chest and heartburn....so bad that I almost went to the hospital. I was severely constipated and it has taken me 3 weeks to clean out my system. I am suspecting CIPO and I have some questions. Regarding the manometry test 1) do you need to eat something and if so what do you need to eat? Could I drink a juice or clear liquid? 2) How long is the test? 3) What is the difference between the colonic, esophageal, anto-deudonal manometry? 4)will these tests check out the small and large intestine? With regard to the full thickness biopsy 1) What are they looking for in the biopsies? 2) can they identify where the problem is if they only do one biopsy in the small intestine and one in the large intestine? 3) Can they tell by the biopsy whether this is a muscle or nerve problem 4) what are the dangers? I read on this board that their can be problems. 5) How long would this testing take? 6) Could you get a false reading from this since they could take a biopsy where your intestine is not diseased? I know this is a lot of questions, but if anyone could give me some help on this I would greatly appreciate it. I want to have some knowledge when I see the doctor. Thanks so much.
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Testing for Cipo
- By JEM
- Posted September 29, 2009 at 12:59 am · 2 replies
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- By pelztier
- Posted September 29, 2009 at 12:55 pm
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hi jem,
I have CIP and was diagnosed with it last December by undergoing a small bowel manometry (or antroduodenal manometry) and making x-rays from my abdomen. I also had a CT scan, an anorectal and a esophageal manometry.
The basic test for CIP however are the small bowel manometry and the x-rays.
Small bowel manometry last at least 6 hours if you do it in the hospital. There is also a ambulatory 24h- manometry where you can go home and eat everything trhough the day which you normally have and where you are supposed to behave like always.
First of all your contractile pattern of the small bowel is recorded during the fasting state (you are not allowed to eat before) which last at least 5-6 hours. Then you get a standard meal (which is solid since they want to see the reaction of your bowel towards normal food) and your postprandial activity is recorded (both from the stomach and the small bowel). The overall lenght depends on the function of your bowel. The little it is the longer the test takes time.
With the manometry you can see typical pathological contractile patterns that fit the neurogenic variant of CIP (meaning the problem arises in the nerves) or that fit the myopathic variant (meaning that the problem results from damage to the smooth muscles of the gut).
However, with the mamometry you cannot say definitely if it is a problem arising from the nerves or from the muscles. This can only be done a small bowel/large bowel biopsy.
They will have to do a laparoscopy to get the appropriate tissue (full-thickness samples) which is beneath the tissue you can collect during an endoscopy.
The risks are the same as for every other surgery where you open the abdomen. Additionally you can experience a prolonged ileus if you already have motility problems with your small bowel.
In the biopsies they are looking for damages to the smooth muscle cells or damages to the enteric nervous system. There are various lesions which are decribed, degenerative and inflammatory ones etc.
If something is dectected you will have a definite diagnosis of CIP. However, a biopsy is not mandatory for the diagnosis of CIP if your clinical history, your symptoms, the small bowel manometry all fit the clinical image of CIP. Moreover most docs consider the presence of air-fluid/distended bowel loops on plain films which are a sign of a sub-occlusion-like state as mandatory for the diagnosis. If they are not present you will get the diagnosis of bowel motility dysfunction. But there are also docs that are not so strict since the dilated bowel loops mostly occur in a later stage of the disease.
I don't think that you can get a false positive diagnosis by biopsies very often. There is a little possibility that the tissue may be damaged by the surgeons and that this damage may be considered as caused by the condition.
But it is mor likely that you can have a negative biopsy though you have CIP. First of all the bowel can have parts where it is not diseased or where the condition is less sever so that changes cannot be deteceted but in a later stage.
Moreover there are people with CIP where you can't find anthing (maybe very little/minor changes) but who suffer from CIP. That is bascially due to the fact that CIP is not well known and recognized and explored. So the causes for the this condition are various and not well understood.
The anorectal mamometry test your function of your anal spincters. The esophageal manometry is a test to prove dysfunction of the esophag. With CIP all of the digestive tract can be affected though most people have a location where the disease is worst. By definition the small bowel has to be affected, moreover your colon can be diseased as well as your stomach etc. Gastroparesis is a problem that is mostly found with CIP.
In some people (like myself) the bladder can lose its right function, too.
A colon manometry doesn't have to be done. There is a much easier test where you swallow capsules with radioactive material in it. Then x-rays are taken and after a weeks they see if and where the capsules are stuck in the colon. This way your transit time of the colon can be estimated.
I hope I could answer your questions. Sorry for my English, I am German and 23 ys. old.
Sarah
- By JEM
- Posted October 3, 2009 at 9:02 pm
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Thanks so much for all that info. It seems I have a lot to learn and think about. You did answer just about all of my questions and I am so grateful. I am at the point where I think my intestines may be shot. Even drinking a little juice gives me unbearable nausea, gas, pain in the chest and overall sick feeling. I am praying that they will be able to do the testing with some sort of alternative for me, but I have been on a liquid diet for 2 years now, and now I can't even tolerate the juice. I just went through a severe episode where it seemed everything just stopped, and I was so sick and constipated. It took almost 4 weeks to clean myself out and it was absolutely excruiating. At any rate thank you for sharing all of your knowledge. I really appreciate it.
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