Gastrointestinal motility disorders are a group of medical conditions that cause problems with peristalsis (the muscular contractions that move food through the digestive tract). When this happens, you can experience a variety of symptoms depending on which part of the digestive tract is affected. These include heartburn, regurgitation, choking, abdominal pain, diarrhea, and constipation.
Gastrointestinal motility can be impaired due to:
- Aproblem within the muscles that control peristalsis
- A problem with the nerves or hormones that govern the muscular contractions
There are many conditions that can lead to one or both of these problems.
This article explains why people experience peristalsis problems and describes the different medical conditions that fall under the umbrella of gastrointestinal motility disorders. It also describes the various treatments and lifestyle changes that can help relieve symptoms.
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What Is Gastric Motility?
In normal digestion, food is moved through the digestive tract by rhythmic contractions called peristalsis. This process is referred to as gastrointestinal motility (if it involves any part of the digestive tract) or gastric motility (if it involves the stomach).
Once you swallow food, it is moved down the esophagus (feeding tube) by peristalsis. The muscles in the stomach,small intestine, andlarge intestine then continue the process, keeping the food moving as it is broken down by digestive juices (including stomach acids, enzymes, and bile). At the end of the journey, the digested food is excreted through the anus as stool.
With motility disorders, this process can happen more quickly or slowly than normal. The disruption of the normal digestive process can cause symptoms, both minor and severe.
Symptoms of Peristalsis Problems
Gastrointestinal motility disorders may cause a wide range of symptoms, depending on the nature and location of the motility disruption, including:
- Difficulty swallowing
- Choking
- Heartburn
- Burping
- Acid reflux
- Regurgitation
- A feeling of early fullness
- Stomach pain
- Nausea
- Vomiting
- Gas
- Bloating
- Abdominal cramping
- Diarrhea
- Constipation
Types of Motility Disorders
Here are six common and uncommon conditions associated with gastrointestinal motility dysfunction:
Gastroparesis
Gastroparesis, also known as delayed gastric emptying, occurs when the stomach is slow in emptying itself.
Your stomach muscles govern the movement of partly digested food through into the small intestine. When the nerves that control the stomach muscles are damaged, food will move too slowly, causing nausea, burping, bloating, heartburn, indigestion, regurgitation, or vomiting.
Achalasia
Achalasia is the dysfunction of the ring of muscle at the bottom of your esophagus through which food enters the stomach, called the lower esophageal sphincter (LES). When you have achalasia, the LES fails to relax during swallowing so food doesn't move as easily in the esophagus.
Symptoms include chest pain, regurgitation, heartburn, and difficulty swallowing.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) isa chronic disorder of the digestive tract that occurs when the LES is not closing properly. This allows stomach acid to backflow into the esophagus, causing heartburn, chest pain, nausea, and an acid taste in the mouth.
Acid reflux and heartburn occurring more than twice a week may indicate GERD. In some cases, the symptoms are so severe that they mimic those of a heart attack.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a functional digestive condition, which means that it affects how your digestive system works but doesn't damage the digestive organs themselves.
When you have IBS, your digestive motility moves either too quickly or too slowly, leading to diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C), or mixed-type IBS (IBD-M). Other symptoms include stomach pain, rectal pain, cramping, nausea, bloating, and gas.
Hirschsprung's Disease
Hirschsprung's disease is a congenital disorder in which the disruption of peristalsis causes a blockage in the large intestine. The condition is most common in younger boys and is often seen with other congenital disorders, such as Down syndrome.
Chronic Intestinal Pseudo-Obstruction
Chronic intestinal pseudo-obstruction (CIPO) is a rare condition that causes symptoms mimicking a bowel obstruction. But with CIPO, no blockage of any kind is present. In essence, peristalsis simply stops.
CIPO is caused by nerve problems that disrupt the movement of food, fluid, and air through not only the large intestine (bowel) but also the esophagus, stomach, small intestine, and rectum.
What Causes Peristalsis Problems?
In many cases, gastric motility disorders are idiopathic, meaning there is no known cause. However, there are several risk factors associated with peristalsis problems in adults and children.
Underlying Conditions
Gastric motility problems are closely linked to diseases that either damage nerves or impair the production of hormones involved in peristalsis, such as:
- Diabetes: It is estimated that 20% to 50% of people with diabetes have gastroparesis. High blood sugar levels can gradually damage the nerves regulating normal peristalsis.
- Scleroderma: Scleroderma is an autoimmune disease that causes a tightening of tissues, including those in your digestive system. CIPO and GERD are common in people with scleroderma.
- Neurological disorders: Nerve-related diseases that can affect gastric motility include stroke, Parkinson's disease, and multiple sclerosis.
- Hypothyroidism: Studies have found that hypothyroidism (low thyroid function) is closely associated with decreased gastric motility.
Genetics
Genes are thought to play a role in certain gastric motility disorders, such as GERD, Hirschsprung's disease, and CIP. Autoimmune diseases associated with motility dysfunction can also be genetic.
Medications
Opioid pain medications such as hydrocodone and oxycodone can slow gastric motility and cause constipation. It is thought that as many as 81% of people who take opioids experience constipation.
How Are Gastric Motility Disorders Treated?
Different gastric motility disorders are treated differently. Treatment options range from diet and lifestyle changes to medications and surgery.
Lifestyle
Maintaining a healthy diet and making small changes to your eating habits can help manage many different gastric motility disorders. This includes eating smaller meals throughout the day to avoid overtaxing the digestive tract and eating softer foods like:
- Ground meat, poultry, or seafood
- Well-cooked fruits and vegetables
- Soft pasta and rice
- Low-fat dairy
Getting regular aerobic exercise is thought to improve gastrointestinal motility in some people. It's commonly recommended to help treat and prevent constipation associated with IBS-C.
Quitting cigarettes also helps as it reduces the generalized inflammation of the digestive tract which, in turn, can make the stomach and intestines more sensitive to food triggers.
Medications
Medications commonly used to treat gastric motility disorders include:
- Antacids: Including Rolaids and Tums, used for GERD
- Antiemetics: Used to treat nausea associated with GERD, achalasia, and gastroparesis
- Antidiarrheals: Including Imodium (loperamide) and Viberzi (eluxadoline),used to treat diarrhea associated with IBS-D
- Botulinum toxin injections: Also known as Botox, used to treat achalasia and gastroparesis
- Calcium-channel blockers: Used to treat achalasia
- H2 blockers: Such as Pepcid AC (famotidine) and Zantac 360 (famotidine), used to treat GERD
- Laxative and stool softeners: Used to treat constipation associated with IBS-C
- Prokinetic drugs: Including Linzess (linaclotide) and Reglan (metoclopramide), used to treat gastroparesis and IBS-C
- Proton pump inhibitors (PPIs): Such as Nexium (esomeprazole) and Prilosec (omeprazole), used to treat GERD and gastroparesis
Surgery
If conservative treatments fail to improve your symptoms, your gastroenterologist may recommend surgery specific to the condition you have.
Options include:
- Nissen fundoplication: This surgery, used to treat GERD, involves the tightening of the LES to prevent acid reflux.
- Heller myotomy: This surgery, used to treat achalasia, involves making cuts on the lower and upper esophageal sphincter to relieve chronic swallowing problems.
- Pyloroplasty: This surgery, used to treat gastroparesis, widens the valve separating the stomach from the small intestine, called the pyloric valve. This allows the stomach to empty more quickly.
