Motility Disorders of the Stomach and Small Intestine

Abstract

Abstract Gastrointestinal dysmotility represents a severe constellation of symptoms resulting from malfunction of the stomach, small intestine, or large intestine. By definition excluding organic origins of obstruction, the etiologies of the condition range from diabetes to Parkinson’s to more exotic myopathies, although idiopathy remains the most commonly cited cause. Patient presentation typically includes epigastric pain, nausea, vomiting, early satiety, and poor oral intake; constipation characterizes lower GI dysmotility. Severity of the symptoms can range from mildly aggravating to requiring a feeding jejunostomy or even total parental nutrition for survival. CT scan, EGD, and barium swallow are helpful to rule out organic causes, but nuclear medicine emptying studies are required to make diagnosis. Treatment options remain poor. Symptomatic relief with various anti-nausea medications can alleviate minor cases. Metoclopromide remains the only FDA-approved medication for gastroparesis but comes with well-described, severe side effects. Other, more exotic interventions like intrapyloric botulinum injections and implanted gastric pacemakers lack convincing evidence of efficacy. More dramatic, surgical cures like pyloroplasty, jejunostomy feeding tubes, and even small bowel transplant are indicated in particularly severe cases.