Idiopathic intestinal pseudoobstruction. Report of a case, with intraluminal studies of mechanical and electrical activity, and response to drugs

Intraluminal recordings of motility were made from a patient with chronic idiopathic intestinal pseudoobstruction. Contractile activity was recorded from esophagus and duodenum with and without cholinergic stimulation. Electrical activity was recorded from duodenum with and without cholinergic stimulation. Contractile and electrical activities were recorded from the sigmoid colon at rest and after morphine. Gastric fundic relaxation was measured during balloon distention. This patient showed abnormalities of esophageal function similar to achalasia, while gastric fundic relaxation was impaired, with a more rapid rise in pressure on distention than is seen in normal persons. Duodenal and colonic electrical control and response activities were present on occasion. Duodenal contractions occurred in response to both bethanechol and edrophonium. Therefore, the efferent cholinergic system of the small bowel appears to be functional in this case of idiopathic intestinal pseudoobstruction. The nonadrenergic inhibitory control of esophagus and gastric fundus appears to be functioning abnormally.