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Nutritional supports and current management have improved in part the prognosis, although several unmet needs challenge physicians. Prokinetic drugs may facilitate enteral nutrition (EN)\/oral feeding (OF) and decrease parenteral nutrition (PN). Pyridostigmine has been effectively used in adults with severe gut dysmotility; however, experience in PIPO patients is still limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients intolerant to EN\/OF in the previous 6 months were treated with pyridostigmine. We studied nutritional outcomes (caloric intake by EN\/OF and PN as well as growth) at the beginning and after 6 and 12 months of pyridostigmine. Also, we collected clinical outcomes 12 months before and after pyridostigmine treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 10 patients were included in the data analysis. Pyridostigmine (0.44\u20133.4\u2009mg\/Kg\/day) resulted in a significant increase in EN tolerance: median caloric intake by EN\/OF was &gt;25% at 12 months (<jats:italic>p<\/jats:italic>\u2009=\u20090.0156). In two patients, we achieved complete weaning from PN. In all patients, there was an amelioration of growth (increase in median weight <jats:italic>z<\/jats:italic>\u2010score from \u22121.3 to \u22120.9) and a reduction in the number of hospitalizations and central line\u2010associated bloodstream infections in the year following pyridostigmine treatment. Only one patient developed pyridostigmine\u2010related bradycardia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study showed that pyridostigmine supported the nutritional management by improving EN\/OF tolerance and reducing PN dependence. Our data provide a basis for future, ad hoc designed clinical trials testing pyridostigmine in PIPO.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.70171","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T10:15:20Z","timestamp":1754302520000},"page":"967-974","source":"Crossref","is-referenced-by-count":3,"title":["Pyridostigmine improves feeding tolerance in pediatric intestinal pseudo\u2010obstruction: A single\u2010center analysis"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2464-0913","authenticated-orcid":false,"given":"Teresa","family":"Capriati","sequence":"first","affiliation":[{"name":"Gastroenterology and Nutritional Rehabilitation, \u201cBambino Ges\u00f9\u201d Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"De Giorgio","sequence":"additional","affiliation":[{"name":"Department of Translational Science University of Ferrara 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