What is dysmotility?
Dysmotility occurs when the intestinal tract loses its ability to coordinate the muscular contractions of the bowel. With intestinal dysmotility, certain muscles, including the esophagus, stomach, and small and large intestines fail to work normally when moving food, drink and medication through the gastrointestinal tract.
As a result, the esophagus, stomach and intestine may distend, causing pain in the affected area.
There are two common types of dysmotility:
- Intestinal dysmotility of the stomach (often called gastroparesis)
- Intestinal dysmotility of the intestines (often called intestinal pseudo-obstruction)
What is gastroparesis?
With gastroparesis, the ability of the stomach to empty its contents is reduced in the absence of any mechanical blockage. While its exact cause is largely unknown, it may be the result of disruption of nerve signals to the stomach.
What causes gastroparesis?
- Gastric surgeries (surgery that removes part of the stomach, etc.)
- Systemic sclerosis and other connective tissue disorders
- Anticholinergics (medications that block certain nerve signals)
Symptoms of gastroparesis
- Abdominal pain
- Nausea or vomiting
- Sense of abdominal fullness before completing a meal
- Weight loss
What is intestinal pseudo-obstruction?
With intestinal pseudo-obstruction, you may have symptoms of intestinal blockage without any actual blockage. This condition occurs when the small or large intestines lose their ability to contract and push food, stool and air through the gastrointestinal tract. Onset can be sudden (acute) or over time (chronic) and it is more common in children and older adults.
Additional risk factors are:
- Cerebral palsy or other neurologic disorders
- Chronic kidney, lung or heart disease
- Being bedridden or staying in bed for long periods of time
- Narcotic pain medications or other medicines that slow intestinal movements (often called anticholinergic drugs)
Symptoms of intestinal pseudo-obstruction
- Abdominal pain
- Nausea and vomiting
- Swollen or distended abdomen
- Weight loss
For gastroparesis, after a physical examination your doctor may order the following tests:
- Esophagogastroduodenoscopy (EGD)
- Gastric emptying study (using isotope labeling)
- Upper GI series
- Wireless motility capsule testing
- Blood testing for diabetes and thyroid disorders
For intestinal pseudo-obstruction, your healthcare provider will usually see abdominal bloating and may order the following tests:
- Abdominal X-ray
- Anorectal manometry
- Barium swallow, barium small bowel follow-through or barium enema
- Blood tests for nutritional or vitamin deficiencies
- Esophageal manometry
- Gastric emptying radionuclide scan
- Intestinal radionuclide scan
For gastroparesis, patients with diabetes will need to optimize their blood sugar levels and ingest small meals and soft foods to help improve the symptoms.
Other treatment includes:
- Cholinergic drugs to help nerve receptors move along stomach contents
- Antibiotics (like erythromycin)
- Metoclopramide to help empty the stomach
- Serotonin agonist drugs (which act on serotonin receptors) or dopamine antagonist drugs
- Gastroenterostomy surgery — a procedure that creates an opening between the stomach and small intestine to allow food to move through the digestive tract more easily
For pseudo-obstruction, most acute cases get better in a few days with treatment. However, with chronic forms of the disease, symptoms can return and worsen for many years.
Treatments vary widely and may include:
- Stopping medications, such as narcotics, that may have caused the problem
- Colonoscopy to remove air from the large intestine
- Intravenous fluids to replace those lost through vomiting or diarrhea
- Nasogastric suction, in which a nasogastric (NG) tube is placed through the nose into the stomach to remove air from the bowel
- Neostigmine, a drug that inhibits an enzyme known acetyl-cholinesterase, for patients who have Ogilvie’s syndrome, pseudo-obstruction limited to the large bowel
- Giving patients with vitamin deficiency B12 and other supplements