Gastrointestinal Motility Disorder
Gastrointestinal motility disorders affect how food and waste move through your digestive system, disrupting the normal rhythm of muscle contractions and causing symptoms that can significantly impact your daily life and nutrition.
Table of contents
- What is a gastrointestinal motility disorder?
- Signs and symptoms
- What causes motility disorders?
- Types of motility disorders
- How are motility disorders diagnosed?
- Treatment options
- Living with a motility disorder
What is a gastrointestinal motility disorder?
Gastrointestinal motility disorders are digestive problems that happen when the nerves or muscles of the gut do not work in a coordinated way.[1] Motility is a term used to describe the contraction of the muscles that mix and propel contents through the gastrointestinal (GI) tract, which includes your esophagus, stomach, intestines, and colon.[2]
In a healthy digestive system, food moves through your body in a controlled way. Muscles push food along in a process known as peristalsis, which is the progressive wave of contraction and relaxation of the muscular gut tube.[3] Special ring-shaped muscles called sphincters act as valves to stop food from flowing backward. These movements are controlled by the enteric nervous system, sometimes called the “second brain,” which works with your brain through nerves like the vagus nerve.[4]
When you have a motility disorder, these processes do not work as they should. A child or adult may experience problems in any area of the digestive tract, resulting in weak, spastic, or failed movement of food through the digestive system.[5] This may cause food to move slower or faster than it should, or allow it to move backward when it should not.[6]
- Esophagus
- Stomach
- Small intestine
- Colon (large intestine)
- Rectum
- Pelvic floor
Signs and symptoms
Symptoms depend on which area of the digestive tract is involved. Motility disorder symptoms vary based on which organ is affected.[7] In general, you might have a motility issue if you experience certain ongoing problems in your throat, chest, stomach, or bowels.[8]
Upper intestinal motility disorders, which affect the esophagus and stomach, may show up as:[9]
- Difficulty swallowing
- Reflux, or back-up of food in the throat
- Heartburn
- Burping
- Regurgitation of food
- A feeling of early fullness when eating
- Nausea
- Vomiting
- Abdominal pain or swelling
- Weight loss
- Chest pain
Lower intestinal motility disorders, which affect the intestines and colon, may appear as:[10]
- Severe constipation
- Diarrhea
- Excessive gas
- Bloating
- Abdominal discomfort or pain
- Stool incontinence, or involuntary leakage of stool
- Recurrent obstruction
These conditions can significantly impact daily activities and nutrition. Bloating and pain can make it challenging to engage in physical activities or even maintain a regular work schedule. Nutritionally, these conditions can compromise the body’s ability to absorb nutrients effectively, leading to nutritional deficiencies.[11]
What causes motility disorders?
Causes of intestinal motility disorders appear to be multifactorial, and only a few have been clearly identified.[12] These disorders can result from damage to nerves, muscle, or both of these components.[13]
Common causes and contributing factors include:[14]
- Genetics
- Nerve damage, including damage from diabetes
- Muscle dysfunction
- Certain medications, such as narcotics or opioids
- Environmental exposures
- Major stomach or abdominal surgery
- Thyroid disease
- Neurological conditions, such as Parkinson’s disease
- Autoimmune disorders
Very often, motility problems may be due to drug side effects. For example, the antibiotic erythromycin can cause diarrhea by stimulating gut motility, while narcotics can cause constipation by suppressing gut motility.[15] Many motility disorders have no known cause but are very common. Some are less common but can be life-threatening, such as gastroparesis or intestinal pseudo-obstruction.[16]
Types of motility disorders
Intestinal motility disorders can be categorized based on where they occur in the digestive system. Doctors broadly divide the digestive tract into upper and lower sections.[17]
Upper gastrointestinal motility disorders affect the esophagus and stomach and include:[18]
- Achalasia: Loss of esophageal peristalsis, with failure of the lower esophageal sphincter to relax, making it difficult for food and liquid to pass into your stomach
- Gastroesophageal reflux disease (GERD): Reflux of gastric contents from the stomach into the esophagus, causing heartburn and resulting in tissue damage
- Gastroparesis: Delayed gastric emptying without evidence of mechanical obstruction, resulting in poor stomach emptying and symptoms of nausea, vomiting, abdominal pain, or weight loss
- Dysphagia: Difficulty or discomfort in swallowing
- Functional dyspepsia: Recurring upset stomach, bloating, discomfort, or pain in the belly that occurs when there is no evidence of an underlying disease
- Cyclic vomiting syndrome: A condition causing episodes of severe vomiting
Lower gastrointestinal motility disorders affect the intestines and colon and include:[19]
- Irritable bowel syndrome (IBS): Chronic abdominal pain with changes in bowel habits without an organic cause, which can be diarrhea-predominant, constipation-predominant, or mixed
- Colonic inertia: Delayed passage of stool through the colon without abnormalities in the defecation process, resulting in constipation
- Intestinal pseudo-obstruction: Acute severe intestinal dilatation without an anatomic obstruction or process
- Pelvic floor dyssynergia: A functional obstruction from impaired relaxation of muscles, causing difficulty in evacuation of stool
- Hirschsprung’s disease: Also known as congenital aganglionic megacolon, in which the distal section of the colon that is missing nerve cells fails to relax, causing a functional obstruction
- Fecal incontinence: Involuntary leakage of stool
- Chronic constipation: Persistent difficulty with bowel movements
Some motility disorders only affect one portion of the digestive tract, while others may involve or progress to multiple areas within the digestive tract. In certain instances, motility disorders may also affect the urinary system.[20]
How are motility disorders diagnosed?
To diagnose motility disorders, your doctor will conduct a physical exam, discuss your medical history, review your medications, and ask questions about your symptoms.[21] Your pediatric gastroenterologist or adult specialist will obtain a thorough history and perform a complete physical examination.[22]
Depending on your symptoms, you may undergo blood work, x-rays, and further advanced diagnostic testing. Advanced diagnostic technology helps doctors understand your condition and pinpoint the root cause of your symptoms.[23]
Common diagnostic tests include:
For the esophagus:
- Esophageal manometry: Measures the function of your esophagus muscles by tracking pressures and patterns of muscle contractions. A thin, flexible tube with sensors is placed through your nose into your esophagus while you swallow water.[24]
- EndoFLIP: A newer tool that measures motility through the esophagus using a catheter attached to a balloon placed in your mouth while you’re asleep[25]
- pH monitoring: Tests to measure acid levels in your esophagus over 24 or 48 hours to detect reflux[26]
- Upper endoscopy: Allows your doctor to visually inspect the interior of your upper GI tract[27]
For the stomach:
- Gastric emptying scan: Assesses how quickly your stomach empties food into the small intestine[28]
- SmartPill wireless motility capsule: A pill-sized sensor that you swallow which measures temperature, pH, and pressure as it travels through your digestive system for five days. It collects data to help diagnose conditions including gastroparesis, intestinal pseudo-obstruction, colonic inertia, and constipation.[29]
For the intestines:
- Breath tests: Evaluates for carbohydrate malabsorption and small intestinal bacterial overgrowth (SIBO)[30]
- Video-capsule endoscopy: A pill-sized camera that takes photos from inside your small intestines[31]
- Colonoscopy: Allows visualization of the large intestine[32]
For the colon and rectum:
- Anorectal manometry: Explores the function of the rectum and anus[33]
- Colon manometry: Measures pressures in the colon[34]
Often, doctors begin with a colonoscopy or endoscopy exam to visualize the GI tract and rule out any structural issues. Then, they use additional specialized tests to further evaluate a particular organ based on your symptoms.[35]
Treatment options
There are many treatment options for motility disorders, including medication, diet modification, and surgery. Your gastroenterologist will work closely with you to understand your diagnosis, symptoms, and goals for treatment. Together, you will create a unique plan that addresses your concerns and relieves your symptoms.[36]
Several different drugs can cause intestinal motility disorders, therefore avoiding them, if possible, may resolve the condition. In selected patients, pharmacotherapy may be helpful.[37] Treatment that targets the underlying mechanisms causing your symptoms provides the best outcomes.[38]
Lifestyle and dietary changes:
Maintaining a healthy diet and making small changes to your eating habits can help manage many different motility disorders. Your gastroenterologist will discuss which diet is best for you and may refer you to a dietitian to help you make healthy changes.[39] Dietary modifications and nutrition management become critical for individuals with GI motility disorders, focusing on foods that are easier to digest and nutrient-packed to compensate for malabsorption.[40]
Your motility diet may include:[41]
- Well-cooked fruits and vegetables
- Soft pasta
- Liquid-based diets
- Ground or pureed meat, poultry, or seafood
- Low-fat dairy
- Smaller, more frequent meals
- Avoiding high-fiber or high-fat foods that are harder to digest
Medications:
There are many medications that can help provide relief from the symptoms of a wide range of motility disorders, depending on the condition you suffer from and the severity of your symptoms.[42]
Common medications include:
- Prokinetic agents (also called promotility agents): Help the stomach and intestines empty more quickly[43]
- Antiemetic agents: Medications to treat nausea and vomiting[44]
- Antispasmodics: Help relax intestinal muscles[45]
- Laxatives: Help with constipation[46]
- Antacids and acid reducers: Help neutralize stomach acid for GERD[47]
- Botulinum toxin (Botox) injections: Can help relax muscles in the esophagus or stomach[48]
- Antibiotics: May be used for certain conditions like small intestinal bacterial overgrowth[49]
Behavioral and cognitive therapies:
Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have been successful in managing abdominal pain in patients with irritable bowel syndrome.[50] A gastrointestinal psychologist can teach strategies for managing the mental and emotional challenges of a motility disorder.[51]
Surgical and procedural treatments:
Surgery is not usually performed to treat patients with primary intestinal motility disorders, except in the treatment of conditions that do not respond to medical therapies. Surgery for these patients is always aimed at relieving symptoms.[52]
Advanced minimally invasive procedures include:
- Peroral endoscopic myotomy (POEM): A minimally invasive treatment for achalasia and gastroparesis performed entirely through the mouth, where muscles are cut to make swallowing easier or help the stomach empty[53]
- Pneumatic dilation: Where a balloon is used to widen the lower esophageal sphincter for achalasia[54]
- Gastric neurostimulator surgery: Implants a small, battery-powered device beneath your skin that sends electrical pulses to the nerves in your stomach to reduce gastroparesis symptoms[55]
- Feeding tubes: May be used to bypass the stomach to ensure you can maintain nutrition and hydration in severe cases[56]
Living with a motility disorder
Living with a gastrointestinal motility disorder can be challenging, but there are strategies and resources to help you manage your condition and maintain your quality of life.[57]
Your outlook depends on the specific disorder and its severity. The outlook for people with conditions like gastroparesis is improving due to ongoing research in the field. Understanding of these disorders has advanced significantly in the last decade, with new medications and treatments under study.[58]
Working closely with your healthcare team is essential. Being an active member of your healthcare team and maintaining open communication with your healthcare provider helps ensure you get the best care possible.[59] You may work with a team that includes a gastrointestinal motility specialist, as well as experts in surgery, primary care, radiology, nutrition, and other specialties.[60]
Many people find it helpful to connect with others who have similar conditions through support groups. Understanding your condition, following your treatment plan, and making necessary lifestyle adjustments can help you manage symptoms and improve your overall well-being.[61]
