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Gastrointestinal  Tract:  Disorders  of  Motility

Disorders of motility in the gastrointestinal (GI) tract are digestive problems that occur when nerve muscles in the gut are not working in a coordinated way. The disorders might occur in any area of the GI tract resulting in a weak, failed or spastic thrust of food through the digestive system. Some affect a portion of digestive tract while others affect multiple areas from the esophagus at the very top to colon and rectum at the very bottom.

A distinct type of motility and sensation occurs in these parts of the GI tract with a unique contribution to digestion.

  • Esophagus
  • The stomach
  • Small intestine
  • Large intestine
  • Anorectum and pelvic floor

Symptoms of Gastrointestinal Tract Disorders of Motility

Symptoms of GI motility disorders depend on the motility location in the digestive tract and might include:

  • Difficulty swallowing
  • Abdominal pain or swelling
  • Reflux (or back up of food in the throat)
  • A feeling of early fullness
  • Burping
  • Regurgitation
  • Constipation, diarrhea, excessive gas
  • Nausea
  • Vomiting
  • Weight loss

Diagnosis of Gastrointestinal Tract Disorders of Motility

Diagnosis depends on these factors:

1. Assessment of motor function by measuring transit and profile of intestinal pressure

2. Exclusion of mechanical obstruction or structural diseases

3. A search of the underlying disorders that could be causing a myopathy or neuropathy

A gastroenterologist obtains patient history and performs a complete physical examination. Depending on the complaint, a gastroenterologist might order for an x-ray, blood work and advanced diagnostic testing including:

i. Gastric emptying scan for assessing stomach emptying time

ii. Impedance-pH study to detect the presence of reflux with some symptom correlation

iii. Esophageal manometry for tracking the functioning of the esophagus (food pipe)

iv. Sitzmarks capsule for assessment of colonic transit time

v. Anorectal manometry to explore the function of anus and rectum

Causes of Gastrointestinal Tract Disorders of Motility

A. Irritable bowel syndrome.IBS alters digestive motility by causing abnormal abdominal contractions to slow or increase digestion leading to diarrhea or constipation.

B. Diabetes because it increases blood sugar levels

C. Gastroparesis.A condition that slows the ability of the stomach to empty itself because of damage to the nerve that contrail the muscles that move partly digested foods to the intestines through the stomach. It is also called delayed gastric emptying.

D. Hirschsprung's disease. This disease is a congenital disorder the causes a blockage in the large intestine to reduce digestive motility.

E. Esophageal spasms. Esophageal spasms are irregular contractions of muscles in the esophagus, the tube carrying food from the mouth to the stomach. The cause of the contractions that people sometimes mistake for heart-related pain is not apparent.

F. Chronic intestinal pseudo-obstruction: A rare condition that occurs when nerves that control digestive muscles have a problem but appears as if it is a blockage in the large intestine.

G. Scleroderma. Scleroderma is an autoimmune disease that causes tightening of the skin and the connective tissues but also affects the digestive system. Intestinal pseudo-obstruction and GERD are common among the people who have scleroderma.

Treatment and management of Gastrointestinal Tract Disorders of Motility

Management of motility disorders is based on the restoration of proper nutrition. The nature of the disease and symptoms depends on the kind of treatment. A gastroenterologist can use one of these treatments to eliminate the causes of motility disorders.

a. Treating bacterial overgrowth

b. Antiemetics, prokinetic agents, and surgery of localized disease

c. Prescription of opioid agonists and occasionally second-line treatments such octreotide, verapamil or clonidine for fast transit disorders

d. For constipation, a doctor begins with changes in diet, fiber, fluid and concurrent medications. A patient may use irritant laxatives but not habitually because long-term usage has a damaging effect. Polyethylene glycol purgatives offer more benefits to the patients.

e. Newer prokinetic agents like cisapride promote colon motility.

f. Functional diarrhea-opioid analogs help to increase absorption of fluids and delay transit

g. Intractable constipation-Surgery has a high rate of success