Course Summary

Expiration Date: 11/03/2029

Chronic Intestinal Pseudo-obstruction (CIPO) is one of the most challenging and severe motility disorders of the gastrointestinal tract, often described as an “insufficiency of the intestinal pump” and accounting for a significant portion of pediatric intestinal failure. The complex nature of CIPO requires understanding its classification, congenital, acquired, primary, and secondary forms, with a focus on the underlying pathophysiology that distinguishes visceral myopathy (muscle disorders) from the more prevalent visceral neuropathy (nerve disorders). The comprehensive assessment strategies required for diagnosis and the current interprofessional treatment approaches, spanning prokinetic therapies, surgical interventions, and the highly specialized option of small intestinal transplantation, are discussed. Despite high associated morbidity, the prognosis for children with CIPO is improving with aggressive, interprofessional management.

Course Format

Homestudy

Course Syllabus

  • I. Introduction
  • II. Etiology and Pathophysiology
    • 1. Delayed Maturation of the ICC
    • 2. Underlying Conditions
    • 3. Viral Associations
  • III. Assessment and Diagnosis
    • 1. Radiology
    • 2. Manometry
    • 3. Transit Studies
    • 4. Electrogastrography
    • 5. Pathology
  • IV. Prokinetic Therapy
  • V. Surgery
  • VI. Transplantation
  • VII. Other Therapeutic Options
  • VIII. Prognosis and Future Options
  • IX. Case Study: CIPO and Autoimmune Gastric Dysmotility
  • X. Key Takeaway Points

Authors

Marilyn Lajoie, MD, DC, CCSP

Dr. Marilyn Lajoie obtained her medical degree from Saba University School of Medicine in 1999, Her residency began with one year of Anatomical and Surgical Pathology at Orlando Regional Medical Center, before transferring within the same post-graduate residency program to Internal Medicine. Upon completion of residency, she went into private practice in Orlando, where she specialized in Internal Medicine, Sports Medicine and Rehab, as well as acute and chronic pain management. Before becoming a medical doctor, she had practiced as a Chiropractic Physician, graduating from New York Chiropractic College in 1980, practicing initially on Long Island, N.Y., before moving to Florida where she had a successful chiropractic practice and physical rehabilitation center, and gained recognition as a Certified Chiropractic Sports Physician. Dr. Lajoie was also the Director of Physical Therapy at Horizon Hospital, a residential and outpatient psychiatric hospital, and later, continued in the same capacity at Horizon’s sister psychiatric hospital in Brooksville, Florida. Dr. Lajoie maintained her chiropractic license and continued to practice both Internal Medicine and Chiropractic throughout private practice, until moving to the Veterans Healthcare System in 2014. Continuing in both fields, she became the Deputy Chief of Staff for the Montana VA, where she completed her service in 2021. Dr. Lajoie now works predominantly in telemedicine, and in an Expert Witness capacity for both medical and chiropractic cases. Still living in Montana, she enjoys being able to treat not only the rural areas of the state through this technology, but also patients across the US where she maintains multiple active state licenses. She and her husband also own a llama ranch with over thirty llamas that are hand selected for rare genetics. At the llama ranch, the public is invited to come and visit to learn about these elegant creatures, and to see ranch life firsthand – llama style! Dr. Lajoie and her husband have six adult children, as well as seven dogs.

Susan Depasquale, MA, MSN, PMHNP-BC

Susan DePasquale is a board certified Psychiatric Mental Health Nurse Practitioner. Her current practice is with families, youth and adults who have mental illnesses in both inpatient and outpatient settings, including telepsychiatry for Montana, Washington and Wisconsin communities. She completed her Masters of Art in Political Science at the University of Victoria, British Columbia, Masters of Science in Nursing at Seattle Pacific University in Seattle, Washington with a focus in neurogastroenterology and the Post-Masters of Science in Nursing at the Montana State University in Bozeman, Montana with a focus in psychiatry. She has worked with small and rural healthcare teams in British Columbia and the Northwest Territories, Canada, and in teaching and research hospitals such as Providence Health and Virginia Mason Medical Center Digestive and Liver Disease Departments in Seattle. Since 2012, she has been actively involved in online continuing education program development for nurses and health teams.