Abstract：
Chronic intestinal pseudo-obstruction (CIPO) may be a primary or secondary phenomenon and is often multifactorial. Treatment is largely directed at improving colonic motility. The use of cholinesterase inhibitors such as pyridostigmine has been hypothesized to increase acetylcholine in the bowel, improving symptoms and transit times.
A systematic review of the use of pyridostigmine in CIPO was conducted using scientific and commercial search engines identifying scientific studies enrolling adult human subjects, published from 2000 to 2022 in the English language.
Four studies were identified including two randomized controlled trials (RCT) and two observational studies. The studies had heterogenous inclusion criteria, dosing regimens and reported outcomes. Two studies were identified as being at high risk of bias. All studies reported improved patient outcomes with use of pyridostigmine, and low rates (4.3%) of mild cholinergic side effects. No major side effects were reported.
The use of pyridostigmine in management of CIPO is biologically plausible due to its ability to increase colonic motility, and early studies on its role are uniformly suggestive of benefit with low side-effect profile. Four clinical studies have been conducted to date, with small sample sizes, heterogeneity and high risk of bias. Further high-quality studies are required to enable assessment of pyridostigmine\'s utility as an effective management strategy in CIPO.
A systematic review of the use of pyridostigmine in CIPO was conducted using scientific and commercial search engines identifying scientific studies enrolling adult human subjects, published from 2000 to 2022 in the English language.
Four studies were identified including two randomized controlled trials (RCT) and two observational studies. The studies had heterogenous inclusion criteria, dosing regimens and reported outcomes. Two studies were identified as being at high risk of bias. All studies reported improved patient outcomes with use of pyridostigmine, and low rates (4.3%) of mild cholinergic side effects. No major side effects were reported.
The use of pyridostigmine in management of CIPO is biologically plausible due to its ability to increase colonic motility, and early studies on its role are uniformly suggestive of benefit with low side-effect profile. Four clinical studies have been conducted to date, with small sample sizes, heterogeneity and high risk of bias. Further high-quality studies are required to enable assessment of pyridostigmine\'s utility as an effective management strategy in CIPO.
摘要：
背景：慢性假性肠梗阻（CIPO）可能是主要或次要现象，通常是多因素的。治疗主要针对改善结肠运动。胆碱酯酶抑制剂如吡啶斯的明的使用被认为会增加肠道中的乙酰胆碱，改善症状和运输时间。
方法：使用科学和商业搜索引擎对吡啶斯的明在CIPO中的使用进行了系统评价，以确定招募成人受试者的科学研究，2000年至2022年以英语出版。
结果：确定了四项研究，包括两项随机对照试验（RCT）和两项观察性研究。这些研究有异质性的纳入标准，给药方案和报告的结果。两项研究被确定为存在高偏倚风险。所有研究都报告了使用吡啶斯的明改善了患者的预后，轻度胆碱能副作用发生率低(4.3%)。没有报告重大副作用。
结论：在CIPO的管理中使用吡啶斯的明在生物学上是合理的，因为它能够增加结肠运动，对其作用的早期研究一致暗示了副作用低的益处。迄今为止，已经进行了四项临床研究，样本量小，异质性和高偏倚风险。需要进一步的高质量研究来评估吡啶斯的明的效用，作为CIPO中的有效管理策略。
方法：使用科学和商业搜索引擎对吡啶斯的明在CIPO中的使用进行了系统评价，以确定招募成人受试者的科学研究，2000年至2022年以英语出版。
结果：确定了四项研究，包括两项随机对照试验（RCT）和两项观察性研究。这些研究有异质性的纳入标准，给药方案和报告的结果。两项研究被确定为存在高偏倚风险。所有研究都报告了使用吡啶斯的明改善了患者的预后，轻度胆碱能副作用发生率低(4.3%)。没有报告重大副作用。
结论：在CIPO的管理中使用吡啶斯的明在生物学上是合理的，因为它能够增加结肠运动，对其作用的早期研究一致暗示了副作用低的益处。迄今为止，已经进行了四项临床研究，样本量小，异质性和高偏倚风险。需要进一步的高质量研究来评估吡啶斯的明的效用，作为CIPO中的有效管理策略。
