Gastrointestinal Motility

Last updated date: 08-Jan-2023

Originally Written in English

Gastrointestinal Motility

Overview

The digestive system is in charge of digesting. Your body begins this sophisticated process the minute you even glance at food. The flow of food from the mouth via the pharynx (throat), esophagus, stomach, small and large intestines, and out of the body is referred to as gastrointestinal motility (GI).

 

What is a Gastrointestinal (GI) Motility?

Gastrointestinal (GI) Motility

The motions of the digestive system and the transit of its contents are referred to as gastrointestinal (GI) motility. When nerves or muscles in any part of the digestive system do not operate normally, a person suffers symptoms associated with motility difficulties.

There are several motility diseases that can affect the GI tract from the top (esophagus) to the bottom (colon and rectum). Each segment of the GI tract - esophagus, stomach, small intestine, and large intestine - has a particular purpose in digesting and has its own sort of motility and feeling. Symptoms develop when motility or feelings are insufficient for accomplishing this function.

 

The Enteric Nervous System

The Enteric Nervous System

The Enteric Nervous System (ENS) is a self-contained system within the stomach that has its own reflexes and movement control. It is in charge of motility, secretion, and feeling. Peristalsis is the gradual wave of contraction and relaxation of the muscular gut tube via which the contents are propelled through the system.

Most of the time, sensations from the stomach are not noticed unless pain receptors are triggered. These receptors are typically activated by distension of the gut wall, cramping, or inflammation. Usually, as the insult wears off, so does the pain. In certain circumstances, silent pain receptors (called nociceptors) are triggered, which do not "switch off" after the shock has passed, leaving the patient in chronic agony. The causes for this are unknown, however this notion underpins many hypersensitivity illnesses, including post-infectious Irritable Bowel Syndrome (IBS).

Gut motility, secretion, and sensory abnormalities can result in a variety of illnesses and disorders. These problems can result from nerve, muscle, or both ENS components being damaged. Drug side effects, such as diarrhea from the antibiotic erythromycin, which enhances gut motility, or constipation from opioids, which reduce gut motility, are very common causes of motility issues. Many motility abnormalities are frequent yet have no identified etiology (such as IBS). Some are uncommon but potentially fatal, such as gastroparesis or intestinal pseudo-obstruction.

 

What is a Gastrointestinal (GI) Motility Disorder?

Gastrointestinal (GI) Motility Disorder

GI motility issues arise when the nerves and muscles in the gastrointestinal system do not function properly, resulting in aberrant contractions or heightened sensitivity. A motility issue might be present at birth or develop later in life, generally as a result of persistent inflammation or infection in the GI tract. Because motility disorders can occur everywhere in the digestive tract, from the esophagus to the rectum, they are divided into two categories:

  • Upper gastrointestinal motility disorders involve the esophagus, stomach or upper part of the small intestine.
  • Lower gastrointestinal motility disorders involve the small intestine, colon (or large intestine) and rectum.

 

Examples of Gastrointestinal Motility Disorders

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

The most common GERD symptoms, heartburn and acid regurgitation, are so ubiquitous that they may not be linked to a condition. Self-diagnosis might lead to incorrect therapy. A doctor's consultation is required for an accurate diagnosis and treatment of GERD.

GERD can be efficiently treated using a variety of approaches ranging from lifestyle changes to medication or surgical procedures. Individuals suffering with severe heartburn or other chronic and recurring GERD symptoms must get an accurate diagnosis, collaborate with their physician, and receive the most effective therapy possible.

 

Intestinal dysmotility, intestinal pseudo-obstruction

Intestinal blockage symptoms can be caused by abnormal motility patterns in the small intestine. Bloating, discomfort, nausea, and vomiting symptoms can be caused by either mild contractions or disordered (unsynchronized) contractions caused by intestinal muscle (visceral myopathy) or nerve (visceral neuropathy) disorders.

 

Eosinophilic Esophagitis (EoE)

Eosinophilic Esophagitis (EoE) is an esophageal dysfunction characterized by difficulty swallowing (dysphagia), food bolus impactions, and acid reflux (GERD) caused by persistent esophageal inflammation. An increase in inflammation by immune cells such as eosinophils causes this esophageal disease. Food and airborne allergens are most likely aggravating these immune cells.

Eosinophilic Esophagitis (EoE) is growing increasingly widespread and can affect people of all ages, however young adults, particularly men, are more vulnerable. EoE is frequently identified in the emergency room when patients seek treatment for food lodged in their throats (food bolus impaction).

More is being learned about EoE as it becomes more common, but both the cause and the best treatments remain unknown. EoE is currently commonly treated with medicines (oral corticosteroids), a change in diet, and endoscopic dilatation.

 

Small bowel bacterial overgrowth

Small bowel bacterial overgrowth

A buildup of germs in the top region of the small intestine can cause bloating, discomfort, and diarrhea. Symptoms appear quickly after eating because bacteria in the small intestine begin to devour the food before it can be digested. Bacterial overgrowth in the small intestine is caused by aberrant motility.

 

Constipation

Constipation

Constipation symptoms include infrequent bowel movements [typically less than three per week], passage of firm stools, and occasionally difficulty passing stools. A decrease in the number of high amplitude propagating contractions in the large intestine is one motility problem that can lead to constipation. 

 

Outlet obstruction type constipation (pelvic floor dyssynergia)

To avoid leaking, the external anal sphincter, which is part of the pelvic floor, generally remains securely closed. However, when you try to have a bowel movement, this sphincter must open to allow the fecal material to pass. When straining to have a bowel movement, some persons have difficulty relaxing the sphincter muscle, or they may actually press the sphincter more tightly shut. This causes constipation symptoms.

 

Diarrhea

Diarrhea

Diarrhea symptoms include frequent, loose or watery feces and a subjective sensation of urgency. A high number of high amplitude propagating contractions might produce diarrhea because it limits the length of time food residues remain in the large intestine for water resorption. Changes in small intestine motility may also occur, however there is little evidence on this.

 

Fecal incontinence

Fecal incontinence means involuntary passage of fecal material in someone over the age of 4 years. The most common causes are 

  1. Weakness of the anal sphincter muscles;
  2. Loss of sensation for rectal fullness; 
  3. Constipation, in which the rectum fills up and overflows; and
  4. Stiff rectum, in which the fecal material is forced through the rectum so quickly that there is no time to prevent incontinence by squeezing the sphincter muscles.

 Diarrhea can also lead to fecal incontinence.

 

Hirschsprung’s disease

There are two anal sphincter muscles: an internal one that is part of the intestines and an exterior one that is part of the pelvic floor muscles. When the rectum fills up with gas or fecal material, a reflex forces the internal anal sphincter to open, allowing the bowel movement to pass through. The nerves on which this response is dependent are occasionally absent at birth, resulting in the internal anal sphincter remaining securely closed and bowel motions being impossible. Hirschsprung's disease is a congenital (born) disorder.

 

Gastroparesis

Gastroparesis is a condition in which specific symptoms arise and the stomach takes an abnormally lengthy time to discharge its contents. There is no obvious restriction or blockage. The etiology of gastroparesis is unknown in the vast majority of cases (idiopathic). The most prevalent recognized cause of gastroparesis is diabetes. The disease can also occur as a side effect of some surgical operations. Nausea and vomiting are common symptoms of gastroparesis.

Many people have stomach discomfort or pain, which can vary from annoying to incapacitating. Bloating, fullness after eating, or early fullness (satiety) - the inability to complete a meal - are other common symptoms. Depending on the individual, these symptoms may be moderate or severe. Treatment seldom cures gastroparesis, which is generally a chronic illness. However, therapy does help most people manage their disease.

 

Achalasia

Diarrhea

Achalasia is a disease of esophageal motility. It is identified when there is a total absence of peristalsis inside the esophageal body. To enable food into the stomach, the lower esophageal sphincter does not relax. Symptoms include difficulties swallowing liquids as well as solids. Many patients have also reported regurgitation, vomiting, weight loss, and unusual chest pain.

 

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a prevalent disorder in which patients have pain or discomfort before, during, or after a bowel movement, as well as constipation, diarrhea, or both. It is a functional condition defined by aberrant motility and feeling, which can have a substantial impact on daily living. After the common cold, IBS is the second most prevalent cause of job absence.

IBS's cause is still unknown. Treatments focus on working with the patient to make dietary adjustments as well as symptomatic measures such as laxatives or anti-diarrheal medicines and antispasmodic or neuromodulating drugs when pain is a big concern.

 

Colonic Inertia

Colonic inertia is an uncommon condition in which the colon stops working regularly. Severe and persistent constipation is the symptom. Neuromuscular degeneration is the most common cause.

Laxatives, enemas, and rarely surgery are used as treatments. Constipation affects a large number of people, the great majority of whom do not have colonic inertia. Constipation can be caused by a number of drugs used to treat various disorders such as chronic pain, depression, convulsions, and cardiovascular disease. Long-term use of stimulant laxatives can also make the colon less sensitive to regular bowel movement signals, causing the bowel to become sluggish. 

Most people will benefit from dietary changes that include eating more fruits and vegetables, whole grain cereals, beans and legumes, and drinking more water and other fluids on a daily basis. If you continue to have constipation, especially after changing your dietary habits, see your doctor for an evaluation.

 

Gastrointestinal motility disorder symptoms

Gastrointestinal motility disorder

  • Constipation—two or fewer bowel movements each week, hard stools that are difficult to pass, excessive straining when trying to have a bowel movement, feeling that you haven't completely emptied after a bowel movement
  • Chronic diarrhea
  • Difficulty or pain with swallowing
  • Heartburn, acid reflux or unexplained chest pain 
  • Abdominal fullness or swollen stomach
  • Gas, bloating and burping
  • Pain or discomfort in the abdomen or anus
  • Unexplained nausea or vomiting
  • Involuntary leakage of stool
  • Mucus discharge from the anus
  • Pain or bleeding when passing stools

If you have any of the above symptoms, as well as any unexplained digestive difficulties, or if you have not been given a definite diagnosis, the professionals will work with you to determine the source of your problem.

 

Gastrointestinal motility disorder diagnosis

Gastrointestinal motility diagnosed

Despite the fact that motility problems are frequently difficult to identify and manage, strong collaboration between the patient and professionals can result in considerable improvement. Your gastroenterologist will take a comprehensive medical history, discuss your symptoms, check your digestive functioning, and schedule any necessary testing.

  • Basic imaging procedures, such as X-ray, MRI, or CAT-scan, can be performed to determine whether there is any constriction, inflammation, or growth that is causing your symptoms. You may also require a colonoscopy or endoscopy, which entails inserting a tiny camera linked to the end of a flexible tube into your digestive tract while you're sedated to offer a clear look of any problems within your bowels.
  • If the preceding tests do not disclose a clear cause of your symptoms, manometry or transit testing may be necessary.
    • When patients have esophageal symptoms such as heartburn, trouble swallowing, or chest discomfort, esophageal manometry testing is performed. A tiny, pressure-sensitive tube is used in the test to monitor muscular contractions and identify spasms. You may also undergo a test to determine the pH level in your esophagus to determine if you have severe acid reflux.
    • Anorectal manometry testing is commonly used to assess the strength of anal muscles, feelings in the rectum, and reflexes required for appropriate bowel movements in patients suffering from constipation, bloating, or discomfort.
    • The patient consumes food or a tiny capsule to examine how it passes through the digestive tract and how thoroughly the bowels are evacuated during transit investigations.
    • To make it easier to view details on an X-ray or MRI, a patient may consume barium, a chalky white material that covers the interior of your GI system.

Whatever testing is required, your doctor will explain each choice and why it may be beneficial. Ultimately, the objective is to comprehend your individual illness and choose which treatment may be most beneficial in the long run. Although this is not an exhaustive list of all motility disorders, the following are the most prevalent diagnoses:

  • Gastroesophageal reflux disease (GERD) – stomach acid backs up into the esophagus, causing a burning sensation
  • Hiatal hernia – The top portion of your stomach bulges via a tiny rupture in the diaphragm, allowing acid to enter your esophagus.
  • Achalasia – When you swallow, the muscle between your esophagus and stomach does not expand properly, resulting in food backlog.
  • Chronic intractable constipation – bowel incontinence and stiff stools that do not respond to traditional laxative medication or dietary and lifestyle adjustments
  • Spastic esophageal disorder – uncoordinated esophageal muscular contractions that can produce discomfort, trouble swallowing, or vomiting
  • Aerophagia – Excessive air swallowing when talking, eating, or laughing causes belly pain.
  • Chronic pseudo-obstruction – problems with the nerves or muscles prevent food, liquid or air from moving easily through the digestive tract  
  • Gastroparesis – The stomach does not entirely empty, which can cause nausea, vomiting, and blood sugar and nutrition issues.
  • Hirshsprung’s disease – present at birth, the large intestine is missing muscle nerves needed for passing stool

 

Gastrointestinal Motility Disorder Treatment

GMD treatment

Following a diagnosis of any gastrointestinal motility disorder, you will collaborate with the treatment plan, which may include physicians, surgeons, nurses, psychologists, dietitians, physical therapists, and others, to develop a treatment plan that is unique to your situation and lifestyle goals.

Medication, modest dietary or lifestyle adjustments, or other therapy can result in substantial improvements for many people. If these techniques are ineffective or do not generate the desired outcomes, surgery as a more permanent treatment might be explored.

A few examples of treatment:

  • Lifestyle measures to reduce reflux, including stopping use of alcohol or tobacco, eliminating spicy or acidic foods, or wearing more loose-fitting clothes 
  • Diet modifications, such as increasing fiber intake
  • Diaphragmatic breathing to help you change your actual process of breathing and improve breathing efficiency
  • Psychological counseling to change harmful patterns of behavior or introduce helpful habits
  • Physical therapy to strengthen muscles or change the process of eating and drinking 
  • Medication or nutritional supplements
  • Surgery

 

Conclusion

GI motility disorders are digestive issues that occur when the nerves or muscles of the gut do not act in unison. Digestive motility issues can in a variety of forms. Some only affect one part of the digestive tract, whereas others involve or spread to many parts of the digestive tract.