Abstract
DIOS, a common cause of abdominal pain in CF patients, is due to impaction of muco-feculent material in distal ileum and cecum. Conventional therapy with mucolytics, laxatives and retention enemas is often unsatisfactory and may require hospitalization. We have extensive experience with the use of intestinal lavage with Colytely®. 22 CF patients (mean 21.8 yrs, range 13-34 yrs, 15 male) presented with abdominal pain and a mass in the right iliac fossa; 3 vomited and 13 had acute weight loss. In the first lavage 5.6±1.9 L (M±SD) of Golytely® were given p.o. (n=14) or via n-g tube (n=8) over a period of 5.6±2.4 hrs. Body weight and serum electrolytes did not change significantly. No serious side effects occurred. Minor symptoms included bloating (n=12), nausea (n=8), vomiting (n=1), increased urine output (n=7) and chills (n=3). All but one patient reported impressive relief of symptoms, and remained pain-free for an average of 3 months (range 1-19 months). We developed a score to assess DIOS with regard to pain (absent - acute obstruction; range 0-30) and radiological signs of impaction (absent - severe; range 0-30). Lavage led to a significant reduction of pain (20.5±4.9 vs. 1.4±4.7; p <0.0001) and of radiologic score (13.5±5.6 vs. 4.3±5.4; p <0.0001). During follow up of 1-22 months, 8 patients needed a total of 26 (range 1-7) further courses of Golytely®. 6 patients were treated at home, resulting in reduced hospitalization. In our experience intestinal lavage is a well accepted, safe and effective therapy for DIOS.
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Koletzko, S., Stringer, D., Cleghorn, G. et al. TREATMENT OF DISTAL INTESTINAL OBSTRUCTION SYNDROME (DIOS) IN CYSTIC FIBROSIS (CF) WITH AN INTESTINAL LAVAGE SOLUTION. Pediatr Res 21 (Suppl 4), 271 (1987). https://doi.org/10.1203/00006450-198704010-00623
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DOI: https://doi.org/10.1203/00006450-198704010-00623