Patients Care

GASTROINTESTINAL MOTILITY

In normal digestion, food is moved through the digestive tract by rhythmic contractions called peristalsis. When someone suffers from a digestive motility disorder, these contractions are abnormal.

Gastrointestinal (GI) motility is defined by the movements of the digestive system and the transit of the contents within it. When nerves or muscles in any portion of the digestive tract do not function with their normal strength and coordination, a person develops symptoms related to motility problems.

Causes

  • This disorder can be due to one of two causes:
    - A problem within the muscle itself.
    - A problem with the nerves or hormones that control the muscle's contractions.
  • Each part of the GI tract esophagus, stomach, small intestine and large intestine has a unique function to perform in digestion and each has a distinct type of motility and sensation. When motility or sensations are not appropriate for performing this function, symptoms occur.
  • Gastro Esophageal Reflux Disease (GERD)
    - Dysphasia
    - Achalasia
    - Functional Chest Pain
  • The Stomach
    - Delayed Gastric Emptying
    - Rapid Gastric Emptying (Dumping Syndrome)
    - Functional Dyspepsia
    - Cyclic Vomiting Syndrome
  • The Small Intestine
    - Intestinal Dysmotility, Intestinal Pseudo-Obstruction
    - Small Bowel Bacterial Overgrowth
  • The Large Intestine (Colon)
    - Constipation
    - Diarrhea
    - Irritable Bowel Syndrome (IBS)

Signs and Symptoms

  • Difficulty swallowing
  • Heartburn
  • Gas
  • Bloating
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
Gastrointestinal motility disorders may be associated with the following conditions:
  • Irritable bowel syndrome
  • Diabetes
  • Gastro paresis — paralysis of the stomach.
  • Esophageal spasms — irregular contractions of the muscles in the esophagus.
  • Hirschsprung's disease — a congenital disorder in which poor motility causes obstruction of the large intestine.
  • Chronic intestinal pseudo-obstruction — a rare disorder of the muscles and nerves in the intestine.
  • Scleroderma — a progressive hardening and scarring of the skin and connective tissues.
  • Achalasia — an esophageal motility disorder.

Management

  • Current treatment options include: lifestyle changes (increasing water and dietary fiber intake; daily exercise), bulking agent laxatives, stool softening laxatives, osmotic laxatives stimulant laxatives.
  • The main intervention is to increase the intake of water and dietary fiber. The latter may be achieved by consuming more vegetables and whole grain bread. The routine use of laxatives is discouraged as this may result in bowel action becoming dependent upon their use. Exercise has been shown to stimulate bowel motility.
  • Because several different drugs can cause intestinal motility disorders, avoiding them, if possible, may resolve the condition. In patients with primitive intestinal motility disorders, the administration of some drugs may be useful to control symptoms. Broad-spectrum antibiotics may be needed to control bacterial colonization.
  • If the patient is unable to maintain adequate nutritional intake or continues to have severe symptoms despite palliative treatment, long-term home parenteral nutrition may be necessary. Many patients on home parenteral nutrition seem to do well, although some develop sepsis and thrombotic complications.
  • Changes in dietary habits alone can help cure motility disorders. Correct fiber intake is useful in patients with either constipation or stool leakage. Fiber and water must be abundant in the diet of patients with constipation. Patients should avoid fermentable foods.
  • Patients should take small frequent meals (6-8 times/d), avoid foods high in fat or lactose and avoid residue- and gas-producing foods. Consultation with a dietitian helps provide the patient with a number of options.
  • Mild physical exercise is not contraindicated and may be very useful for symptom relief in patients with IBS or constipation.