What is dysmotility?

Dysmotility is a series of related conditions in which the muscles of the digestive tract or the nerves that control them do not work as they should, meaning that the rate at which food passes through the digestive system and the rate at which waste is excreted is abnormally slow or irregular. Bowel dysmotility can lead to some unpleasant digestive symptoms, such as diarrhoea, constipation, bloating, cramping and abdominal pain. The symptoms that appear depend on which part of the digestive tract is affected. Multiple areas of the bowel can be affected and the problem can be progressive.

Dysmotility of the stomach is also known as gastroparesis and that of the large intestine is known as slow transit constipation.

Symptoms of dysmotility

Patients with dysmotility in the upper digestive tract (i.e. the oesophagus and stomach) may experience:

• Loss of appetite
• Weight loss
• Heartburn
• Upper abdominal pain, burning sensations or discomfort
• Nausea and vomiting
• Feeling full very quickly when eating

Dysmotility of the small intestine can cause:

• Abdominal pain
• Cramping
• Bloating and distension
• Problems with bowel movements – this may be constipation and or diarrhoea

Some of these problems may be because of altered gut microbes (small intestinal bacteria overgrowth and small intestinal fungal overgrowth (SIBO/SIFO))

Dysmotility in the lower digestive tract (colon and rectum) can cause:

• Constipation not helped by diet or laxatives
• Lower abdominal pain
• Cramping
• Bloating

Medical tests to diagnose dysmotility

• Blood tests can assess the level of malnutrition, anaemia and salt imbalance that may be caused by dysmotility. They may also be able to diagnose the cause of the dysmotility, e.g. diabetes, lupus, etc.
• CT and MRI scans – these can give the doctor a closer look at what is going on inside the patient and rule out mechanical obstruction.
• Motility/transit investigations
• Small intestinal bacterial overgrowth breath test
• Biopsy

What are the causes of dysmotility?

Dysmotility is caused by dysfunction in the nerves and/or muscles in the organs that make up the gastrointestinal (GI) tract. This may be caused by an underlying illness, such as:

• Systemic lupus erythematosus
• Amyloidosis
• Neurofibromatosis
• Parkinson's disease
• Diabetes
• Scleroderma
• Thyroid disorders
• Muscular dystrophies
• Ehlers-Danlos and other connective tissue disorders

Dysmotility can also be caused by certain medications and inflammatory conditions such as coeliac disease can also cause a certain degree of dysmotility.

In other cases, there is no known cause, and dysmotility is the primary diagnosis. Examples include:

• Achalasia – a dysmotility disorder of the oesophagus
• Gastroparesis – delayed emptying of the stomach
• Functional constipation
• Functional diarrhoea
• Irritable bowel syndrome (IBS)
• Slow transit constipation
• Panenteric dysmotility
• Chronic intermittent pseudo-obstruction

Treatments for dysmotility

The treatment depends on the type and cause of the dysmotility. First, a mechanical blockage must be excluded.

Many causes of dysmotility cannot be cured, meaning that treatment is focused on the symptoms rather than the cause. This may involve dietary changes, medications to stimulate intestinal movements, or manipulation of the gut microbes. Only very rarely is surgery indicated and even then results are unpredictable.

Which type of specialist treats dysmotility?

Bowel dysmotility is managed by neurogastroenterologists. This is a specific subset of gastroenterologists or gastrointestinal surgeons who have had specialist training in this field.