According to a recent article published in the Dove Medical Press of Manchester, UK, intestinal failure centers are receiving an increasing number of adults presenting with gastrointestinal (GI) dysmotility.
Dysmotility is defined as changes in the digestive system such as strength, coordination, and speed due to disruption of digestive organs. Involuntary relaxation and constriction of the muscles of the intestine produce wave-like movements. These movements push the contents of the intestines forward.
Approximately eighteen percent of the patients with dysmotility require parenteral nutrition which is a form of nutrition infused into a vein. It is provided to patients who are unable to absorb nutrients.
GI motility disorders present a major challenge due to the lack of diagnostic tests and treatment options. The first of two sub-classified motility disorders of the small intestine is Chronic Intestinal Pseudo-obstruction (CIPO).
CIPO is a rare and severely disabling disorder based on radiographic signs showing small bowel distention and obstruction. Twenty-five percent of new referrals are diagnosed with potential CIPO.
CIPO is considered to be distinct and has prognostic importance for patients with potential dysmotility. CIPO has been linked to more severe outcomes including:
- Intestinal failure
- Need for surgery
- Higher mortality
- Bacteria overgrowth in the small intestine
It is therefore suggested that radiological imaging is essential for diagnosis. CIPO may affect various areas in the GI tract other than the small intestine in up to ninety percent of cases.
The second sub-classified motility disorder of the small intestine is Enteric Dysmotility. In contrast to CIPO, patients diagnosed with Enteric Dysmotility have impaired small bowel contractility but do not show signs of a dilated intestine.
Symptoms of Gastrointestinal Motility
A variety of symptoms accompany severe GI motility disorders such as pain, vomiting, abdominal distension, or constipation. These symptoms are similar to common GI disorders.
A list of motility disorders includes:
- Dysphagia (trouble swallowing)
- Achalasia (food cannot easily enter the stomach)
- Fecal incontinence (inability to control bowel movements)
- Constipation
- Gastroparesis (when food empties slowly from the stomach)
- Hirschsprung’s disease (nerves of the colon do not grow properly before birth)
- Acid reflux (stomach contents flow backward into the esophagus)
Classification of symptoms relies on certain diagnostic tests. Most of these tests are invasive, difficult to interpret, and not always available.
Testing for Small Bowel Motility
Suitable motility is necessary to move contents through the GI tract. In a number of patients who demonstrate GI symptoms, dysmotility may be evident through physiological testing.
The two most common motility tests are:
- Antroduodenal (small bowel) manometry– The test provides information regarding the muscle activity of the stomach and which area of the GI tract may be affected.
- Esophageal manometry– The test can diagnose several conditions that cause difficulty swallowing. The test also evaluates patients for GERD (gastroesophageal reflux disease.)
In addition, a set of criteria called the Rome criteria is relied upon by physicians to diagnose patients with a disorder of gut-brain interaction.
Screening for secondary systemic causes of myopathy and neuropathy is important. Myopathy refers to a disease affecting muscles that control the body’s voluntary movement.
Surgery, infections, or a specific group of drugs may cause secondary intestinal “pseudo-obstruction”. The term is used to describe GI disorders, each somewhat similar but with a variety of causes involving actions of the nerves and muscles in the intestines.
If, however, the gut is non-dilated, there are a limited number of tests available for small bowel dysmotility.
About Treatment
Until the various tests that are currently available have improved, the suggested approach towards severe GI dysmotility would be targeting the patient’s symptoms using a minimum amount of drugs and avoiding a maximum dose of opioids.
Recently, new information about gut-brain interactions in treating chronic GI pain has led to avoidance of opioids and instead use centrally acting gut-brain neuromodulators (antidepressants, antipsychotics, and other central nervous system−targeted medications).
In conclusion, the authors suggest that symptoms should be targeted with medical and non-medical approaches. Hydration and nutrition status should be optimized using the least invasive methods available. (The complete Dove Medical Press article is available here).
