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Motility Disorders
Kathy Dix
02/01/2006 List of disorders: *Achalasia “Motility disorders” is a broad term that can be applied to any location within the digestive tract — from the esophagus to the rectum. These disorders can involve abnormal contractions of the esophagus, stomach or intestines, and may result in severe abdominal pain, nausea, vomiting, maldigestion, weight loss, diarrhea, constipation and incontinence.1 “Gastrointestinal motility is defined by the movements of the digestive system, and the transit of the contents within it,” according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD).2 The various maladies lumped under the term “motility disorders” include the conditions listed around this article. In achalasia, the lower esophageal sphincter (LES) fails to relax enough to prevent the normal passage of food. Achalasia features a loss of peristalsis, as well as a lack of nervous stimulation to the esophagus. Symptoms include difficulty swallowing, heartburn, cough, chest pain, and weight loss.3 In Barrett’s esophagus, portions of the esophageal lining are replaced by tissue typically found in the intestine, called intestinal metaplasia. Some people with this disorder develop esophageal adenocarcinoma. Barrett’s esophagus may be caused by the same factors that cause GERD; Barrett’s is three to five times more common in people with heartburn than in people without it. There is no cure other than surgical removal of the esophagus; the disorder is more commonly treated with acid blockers, as this may be associated with improvement in the degree of Barrett’s tissue.4 Chronic intestinal pseudoobstruction occurs in many patients with cerebral palsy, lupus, paralysis, and Parkinson’s disease. Symptoms may include vomiting, alternating diarrhea and constipation, dizziness, fatigue, and severe abdominal pain. Treatments are less than ideal, due to poor understanding of the causes of the disorder.1 Cyclic vomiting syndrome (CVS) symptoms include cycles of severe nausea and vomiting that can last hours or days, alternating with symptom-free periods. There is no known cause. Triggers include infections, stress, even allergies. Treatment includes rest, sleep, and acid-reducing medications.5 Gastroparesis, or delayed gastric emptying, is common in diabetics. It can be caused by damage to the vagus nerve, which can be affected by high blood glucose. Signs and symptoms include heartburn, nausea or vomiting, early feeling of fullness, weight loss, appetite loss, and spasms of the stomach wall. Treatment includes regulation of blood glucose levels if the patient is diabetic; medications to stimulate stomach muscle contractions; antibiotics that also increase stomach contractions; promotility agents and antiemetics.6 Hirschsprung’s disease affects the large intestine, causing constipation. The patient lacks ganglion cells in the intestine; these cells typically promote muscle contraction to move waste through the large bowel. The disease typically occurs in children and can also cause diarrhea, anemia, or delayed development. The treatment is surgery to remove the diseased section of intestine.7 Irritable bowel syndrome (IBS) is characterized by cramping, bloating, constipation and diarrhea. IBS affects the large intestine, but does not cause bleeding, cancer, or permanent harm to the intestines. Symptoms may often be controlled by diet, stress management and medications, but can occasionally be disabling. A single cause of IBS has not been identified, but people with this disorder appear to have a colon that is more sensitive and reactive than usual; the immune system may also be involved.8 Pancreatitis, an inflammation of the pancreas, can be acute or chronic; severe cases may feature bleeding, tissue damage, infection, or pseudocysts. Symptoms can include abdominal swelling and tenderness, nausea, vomiting, fever or rapid pulse, dehydration, low blood pressure, even organ failure. Treatment may be supportive, include surgical removal or drainage of pseudocysts, total parenteral nutrition (TPN), and avoidance of alcohol and large meals.9 Rapid gastric emptying, or “dumping syndrome,” occurs when the jejunum fills too quickly with undigested food from the stomach; “early dumping” begins during or immediately after a meal. “Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness and fatigue,” according to the National Digestive Diseases Information Clearinghouse. “‘Late’ dumping happens one to three hours after eating. Symptoms include hypoglycemia, weakness, sweating and dizziness.” The disorder is often caused by certain stomach surgeries, and may also be seen in patients with Zollinger-Ellison syndrome. Treatment includes changes in eating habits and medication to slow digestion.10 Short bowel syndrome affects those who have had at least half of the small intestine removed, a surgery commonly used to treat Crohn’s disease. The main symptom is diarrhea, but other symptoms may include cramping, bloating, and heartburn. Many patients are malnourished, due to the lack of absorptive power by the remaining portion of small intestine. They also may experience dehydration and ensuing weakness, fatigue, depression, weight loss, infections, and food sensitivities. Treatment includes dietary changes, intravenous feeding, vitamin and mineral supplements, and symptom-relieving medication.11 A new tool has recently been released to assist in testing motility from the pharynx to the stomach. The ManoScan 360™ Motility Visualization System senses motor function automatically, and utilizes built-in probe calibration. For more information, view the product listing on page 12. For references, visit www.endonurse.com.
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