Enzimar NF (Lab. Armofar). Metoclopramida (Lab. American Generics S.A). Metoclopramida Bioquín (Lab. ABL Pharma). Metoclopramida (Lab. Antagonistas D2: Haloperidol, clorpromazina, metoclopramida, todos pueden producir efectos extrapiramidales (mov. involuntarios. Sintomatología extrapiramidal, debida a medicamentos. (reserpina Los efectos secundarios ocurren fundamentalmente al iniciar el tratamiento o cuando se de la metoclopramida y de los compuestos análogos.

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Servicio de Medicina de Aparato Digestivo. Hospital Universitario 12 de Octubre. Es poco frecuente pero determina una alta morbilidad. La complejidad de estos enfermos aconseja su seguimiento multidisciplinar. Chronic intestinal pseudo-obstruction CIPO is a syndrome characterized by the presence of recurrent episodes of clinical intestinal obstruction in the absence of obstructive lesions.

Although this syndrome is rare, it causes a high morbidity. It is caused by a disturbance of the intestinal motility, that results in a failure of the progression of the intestinal content. Basically, the failure of the intestinal motility is a consequence of muscular disorder, neurological disorder or both.

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The use of new manometric tecniques and specific histological procedures have allowed to clarify the pathogenesis of some of these entities including mitochondrial diseases and paraneoplasic syndromes. Clinical manifestations of CIPO are diverse, depending on the location and extension of the motility disorder.

As the diagnosis of this disease is usually not extrapiramidalew easy task, patients frecuently undergo unnecesary surgical interventions, are diagnosed of psyquiatric disorders, or the correct diagnosis is delayed several years after the first symptoms arise.

The aims of the treatment are to maintain the nutritional condition and to improve symptoms using nutritional measures, drugs or, eventually, endoscopical or surgical procedures. La prevalencia de la POIC se desconoce. Se estima ve en EE.

La serotonina es liberada desde los mastocitos de la mucosa y activa las terminaciones nerviosas de las neuronas sensoriales para iniciar la peristalsis. En otras enfermedades del tejido conectivo se han referido exgrapiramidales de POIC pero con menor frecuencia que en la esclerodermia 4.

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Algunos casos pueden ser primarios en su origen 8, En las fibras musculares de estos pacientes se puede detectar una deficiencia de citocromo c oxidasa. El dolor puede ser de dos tipos diferentes. Los estudios hormonales tiroideos pueden excluir el hipotiroidismo. La electroforesis proteica en sangre y orina puede poner de manifiesto la existencia de un mieloma.

Por este motivo se debe valorar el hacer las tomas mediante laparoscopia Extrapiramidapes casos de naturaleza inflamatoria o autoinmune pueden responder al tratamiento corticoideo. Los efectos extrapiramidales de la primera hacen que no dxtrapiramidales administrarse dosis altas de la misma. Sin embargo, su eficacia en la POIC es limitada debido al desarrollo de tolerancia si se utiliza de forma prolongada.

No metoclopramids publicaciones al respecto 5, La historia natural de la POIC secundaria depende de la causa subyacente. Los pacientes con esclerodermia habitualmente mueren como consecuencia de complicaciones renales, cardiacas o digestivas.

Curr Treat Options Gastroenterol ; 8: Patel R, Christensen J. Hirano I, Pandolfino J. Z Gastroenterol ; Diagnosis and management of adults patients with chronic intestinal pseudo-obstruction. Nut Clin Prac ; J Royal Coll Ed Edinb ; 3: Chronic idiopathic intestinal pseudo-obstruction.

Am J Med ; Natural history of chronic idiopathic intestinal pseudo-obstruction in adults: Clin Gastroenterol Hepatol ; 3: Keller J, Layer P.

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J Pediatr Gastroenterol Nutr ; 32 Supl. Krishnamurthy S, Schuffler MD. Pathology of neuromuscular disorders of the small intestine and colon.

Gut ; 45 Supl. Role of interstitial cells of Cajal in motility disorders of the bowel. Am J Gastroenterol ; Advances in our understanding of the pathology of chronic intestinal pseudo-obstruction. Neurol Clin ; Intestinal pseudo-obstruction in patients with amyloidosis: Intestinal pseudoobstruction secondary to hypothyroidism.

Importance of small bowel manometry. J Clin Gastroenterol ; DNA viruses in the pathogenesis of sporadic chronic idiopatic intestinal pseudo-obstruction. Neuromuscular diseases of the gastrointestinal tract. Specific disorders than often get a nonspecific diagnosis. Postgrad Med ; Radiologic and histologic differentiation of neuromuscular disorders of the gastrointestinal tract: Am J Roentgenol ; Lyford G, Foxx-Orenstein A. Curr Treat Options Gastroenterol ; 7: Histological phenotypes of enteric smoth muscle disease causing functional intestinal obstruction in chilhood.

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Intestinal pseudo-obstruction with deficient smoth muscle alfa actin. Rev Esp Enferm Dig ; New insights into human enteric neuropathies. Neurogastroenterol Motil ; De Giorgio R, Camilleri M. Sutton I, Winer JB. The inmunopathogenesis of paraneoplastic neurological syndromes. Clin Sci ; Gastrointestinal manifestations of mitochondrial disease. Gastroenterol Clin ; Digestive smooth muscle mitochondrial myopathy in patients with mitochondrial-neuro-gastro-intestinal encephalomyopathy MNGIE.

Gastroenterol Clin Biol ; J Pediatr Gastroenterol Nutr ; Am J Surg Pathol efecots Exxtrapiramidales c oxidase deficiency in two siblings with Leigh encephalomyopathy.

Brain Dev ; 6: Manometric characteristics of cervical dysphagia in a patient with the Kearns-Sayre Syndrome. A novel mitochondrial mutation associated with prominent inicial gastrointestinal symptoms and progressive encephaloneuropathy.

Pediatr Res ; Abnormalities in gastrointestinal motility are associated with diseases of oxidative phosphorylation in children. Ann Neurol ; Definitive diagnosis of mitochondrial neurogastrointestinal encephalomyopathy by l assays.

Clin Chem ; Nucleosides Nucleotides Nucleic Acids ; Seminars in Medicine of the Beth Israel Hospital. Mitochondrial DNA and disease. N Engl J Med ; Neuromuscul Disord ; 2: Clinical characteristics of chronic idiopathic intestinal pseudo-obstruction in adults. Eur J Gastroenterol Hepatol ; The application of radio-opaque markers prior to ileostomy in an infant with chronic intestinal pseudo-obstruction: Surg Today ; Jejunal manometry in distal subacute mechanical obstruction: Colonic manometry in children with defecatory disorders.

Role in diagnosis and management. A typical case of paradoxical motility. Assessment of gastric emptying using a low fat meal: Laparoscopic technique for small bowel biopsy.