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, small and large intestines fail to work normally when moving food, drink and medication through the gastrointestinal tract.
As a result, the stomach and intestine may distend, causing pain in the affected area. While it may involve any part of the gastrointestinal tract, intestinal dysmotility of the stomach is sometimes called gastroparesis, while intestinal dysmotility of the intestines is known as intestinal pseudo-obstruction. Intestinal dysmotility can be mild, moderate or severe and there may be periods when you may have no symptoms.
With gastroparesis, the ability of the stomach to empty its contents is reduced; no blockage is involved. While its exact cause is unknown, it may be the result of disruption of nerve signals to the stomach. Gastroparesis is a common complication of diabetes as well as gastrectomy, a surgery that removes part of the stomach; systemic sclerosis; or it may occur as a result of anticholinergics, medications that block certain nerve signals. Symptoms of gastroparesis include abdominal distention, hypoglycemia (glucose deficiency in the blood) in people with diabetes, nausea, a sense of abdominal fullness before completing a meal, weight loss and vomiting.
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).
For gastroparesis, after a physical examination, your doctor may order the following tests:
- Esophagogastroduodenoscopy (EGD)
- Gastric emptying study (using isotope labeling)
- Upper GI series
For intestinal pseudo-obstruction, your healthcare provider will usually see abdominal bloating and may order the following tests:
- Abdominal X-ray
- Anal 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 control their blood sugar levels and ingest small meals and soft foods to help improve the symptoms. Your doctor may also recommend cholinergic drugs, which may help the nerve receptors to move along stomach contents; Erythromycin (antibiotic); Metoclopramide to help empty the stomach; and erotonin antagonist drugs, which act on serotonin receptors. Other treatments may include injection of Botox (botulinum toxin) into the stomach or a surgery known as a gastroenterostomy 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 ascholinesterase, for patients who have Ogilvie's syndrome, pseudo-obstruction limited to the large bowel
- Giving patients with vitamin deficiency B12 and other supplements