Table 1. Definition and diagnostic criteria for chronic intestinal pseudo-obstruction (CIPO).

Definition of CIPO: Chronic bowel obstruction not explained by structural abnormalities

Criteria for CIPO:

(1) Must include all of the following 4 points:

1. Onset of 1 or more symptoms of bowel obstruction at least 6 months before a diagnosis

2. One or both of the following for the previous 12 weeks

a. Abdominal bloating

b. Abdominal pain

3. Dilatation and/or air-fluid level of the intestine on abdominal X-ray, echo, and/or computed tomography imaging

4. No evidence of structural disease (on upper and lower gastrointestinal endoscopy, computed tomography, barium enema, and small-bowel follow-through) that could explain the dilatation and/or air-fluid level of the intestine

(2) Important considerations:

1. Congenital disease and onset before age 15 years must be excluded; only adult onset is included

2. Surgical history, except surgery for CIPO, within the 6 months before the diagnosis must be excluded to rule out Ogilvie syndrome

3. CIPO is defined as primary or secondary. Primary CIPO consists of 3 types: myogenic, neurogenic, and idiopathic. Secondary CIPO comprises 2 types: SSc and unclassified

4. Family occurrence may be present

5. Neuropathy, such as problems with urination, may be present

6. Some psychosocial disorder may be present

(Research Group of the Ministry of Health, Labour and Welfare, 2009)