Background/Aims: To evaluate the quality of life (QOL) of patients with chronic intestinal pseudo-obstruction (CIPO) before and after treatment. Methods: This study enrolled 50 adult patients diagnosed with CIPO at 4 institutions, of whom 42 underwent therapy.Patient background, body mass index, treatment, palliative care intervention, numerical rating scale for abdominal pain or bloating, the medical outcomes study 36-item short-form health survey (SF-36) and summary scores (physical component summary, mental component summary, and role/social component summary), Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC-QOL) and subscales (physical discomfort, psychosocial discomfort, worries and concerns, and satisfaction), and Patient Assessment of Constipation Symptoms (PAC-SYM) and subscales (stool, rectal, and abdominal symptoms) were prospectively sampled and collected. Results: The patients (n = 50; 35 females and 15 males) had an average age of onset of 44.7 years and, body mass index of 17.3 kg/m², and 38 (76%) required palliative care intervention. Effective therapeutic interventions included intestinal sterilization (19/42), decompression therapy with percutaneous endoscopic gastrojejunostomy (PEG-J) (6/42), and dietary restriction (6/42). The numerical rating scale for abdominal distension and pain decreased significantly after treatment. All SF-36 summary scores showed improvements. The JPAC-QOL and PAC-SYM both showed improvement overall and in all subscales. Conclusions Patients with CIPO have a lower physical, psychological and social QOL, which is equivalent to or lower than that of adult patients with inflammatory bowel disease or psychiatric disorders. Sterilization of the intestinal tract and PEG-J decompression effectively improve the QOL of patients.

Objective: Self-medication is promoted to extend healthy life expectancy. Accordingly, it is important for general consumers to properly use over-the-counter drugs. We investigated whether graphical symbols to visually aid the understanding of drug information (i.e., precautions and instructions to consult with a medical professional) provided in over-the-counter drug package inserts are easily understood in light of the International Organization for Standardization (ISO) criterion of 66％ comprehension. Methods: First, two questionnaire surveys were conducted with pharmacy students to calculate their comprehension level of the illustrations. The first round was for modifying illustrations that did not meet the ISO standard, and the second round was for seeing if comprehension had improved. Then, a questionnaire survey targeting general consumers was conducted to see if these illustrations functioned as graphical symbols. Results: When the referent of “Do not take this medicine if your experience falls under the following conditions” was placed in the upper left corner of the symbol, some students answered that this meant, “If you do not take this medicine, you will be under the following conditions,” but when it was placed in the lower right corner, many students accurately understood the intended information. In the student surveys, one illustration each for “cannot be taken/under treatment/heart,” “cannot be taken/under treatment/stomach,” “cannot be taken/under treatment/liver,” and “cannot be taken/under treatment/kidney” all exceeded 66％. Since none of the illustrations exceeded the 66％ comprehension in the survey of general consumers, it was found to be difficult for general consumers to understand drug information from the present illustrations. However, there were several illustrations that improved in comprehension compared to the previous study, which makes the continuation of this study significant. Conclusion: Although there were no illustrations exceeded 66％ comprehension of general consumers, the study shows that continued improvement may result in establishing pictograms for general consumers.

Background/Aims: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients. Methods: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course. Results: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m2 , 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care. Conclusion CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.