Gastrointestinal Motility Disorders

Esophageal Motility Disorders - Choke & Spasm Tales

• Achalasia: Failure of LES relaxation & aperistalsis.
  • Patho: Myenteric plexus ganglion cell loss.
  • Sx: Dysphagia (solids & liquids), regurgitation, chest pain, weight loss.
  • Dx: Barium (bird's beak), Manometry (gold: ↑LES pressure, incomplete relaxation, aperistalsis).
  • Rx: Dilation, Myotomy, Botox, POEM.
  • 📌 ABCDE: Achalasia, Bird's beak, Chest pain/Chagas, Dysphagia, ES (LES) non-relaxation.
• Diffuse Esophageal Spasm (DES): Uncoordinated, high-amplitude contractions.
  • Sx: Intermittent dysphagia, chest pain (angina mimic).
  • Dx: Manometry (simultaneous, non-peristaltic contractions), Barium (corkscrew).
• Nutcracker Esophagus (Hypertensive Peristalsis):
  • Sx: Dysphagia, chest pain.
  • Dx: Manometry (peristaltic contractions >180 mmHg).
• Hypertensive LES:
  • Dx: Manometry (↑LES pressure >45 mmHg, normal relaxation/peristalsis).
• Ineffective Esophageal Motility (IEM):
  • Dx: Manometry (distal amplitude <30 mmHg in ≥50% swallows).

⭐ Manometry is the gold standard for diagnosing esophageal motility disorders.

Gastric Motility Disorders - Stomach Standstills

• Gastroparesis: Delayed gastric emptying (GE) sans mechanical obstruction.
  • Causes: Diabetes (commonest), post-surgical, idiopathic, meds (opioids, anticholinergics).
  • Sx: Nausea, vomiting (undigested food), early satiety, bloating, abd. pain.
• Diagnosis:
  • R/O obstruction (endoscopy/imaging).
  • Gold Std: Gastric emptying scintigraphy (GES). Abnormal: >60% retention at 2h or >10% at 4h.
• Management:
  • Diet: Small, frequent, low-fat/fiber meals; liquids if severe.
  • Prokinetics: Metoclopramide (⚠️ tardive dyskinesia), Domperidone, Erythromycin (motilin agonist, tachyphylaxis).
  • Antiemetics.
  • Advanced: Botulinum toxin, G-POEM (Gastric Peroral Endoscopic Myotomy), gastric electrical stimulation.

⭐ Diabetic gastroparesis is a frequent complication of diabetes, often linked to autonomic neuropathy. oka

Intestinal Motility Disorders - Bowel Bedlam

• Irritable Bowel Syndrome (IBS): Recurrent abdominal pain (≥1 day/week, last 3 months) + ≥2 of: related to defecation, change in stool frequency, change in stool form (Bristol Stool Chart). Subtypes: IBS-C, IBS-D, IBS-M. Management: Lifestyle, diet (low FODMAP), fiber, antispasmodics (e.g., dicyclomine), loperamide/lubiprostone, TCAs.

  ⭐ Rome IV criteria are key for IBS diagnosis.

• Small Intestinal Bacterial Overgrowth (SIBO): Causes: Motility disorders, anatomical changes, ↓acid. Symptoms: Bloating, diarrhea, malabsorption (B12↓, fat-soluble vit↓). Diagnosis: Glucose/Lactulose breath test (H₂/CH₄ ↑). Gold std: Jejunal aspirate (>10^3 CFU/mL). Treatment: Rifaximin.

• Chronic Intestinal Pseudo-obstruction (CIPO): Severe dysmotility mimicking obstruction; no mechanical block. Types: Neuropathic, Myopathic. Diagnosis: Manometry, biopsy. Management: Supportive, prokinetics.

GI Motility Diagnostics & General Rx - Test & Treat Tactics

• Key Diagnostics:
  • Manometry (esophageal, anorectal): Assesses pressures, sphincter function.
  • Transit Studies: Gastric Emptying Scintigraphy (GES), Wireless Motility Capsule (WMC), Sitz markers.
  • Endoscopy/Biopsy: Rule out mechanical obstruction, mucosal disease.
  • Breath Tests (e.g., H₂): Detect SIBO, malabsorption.
• General Rx Principles:
  • Dietary: Small frequent meals, low FODMAP, fiber modulation.
  • Pharmacotherapy:
    • Prokinetics (e.g., metoclopramide, prucalopride).
    • Antispasmodics (e.g., dicyclomine).
    • Neuromodulators (e.g., TCAs, SSRIs) for pain/visceral hypersensitivity.
  • Biofeedback: For pelvic floor dyssynergia.
  • Empiric trials common.

⭐ Gastric Emptying Scintigraphy (GES) is the gold standard for diagnosing gastroparesis; solid meal retention >60% at 2 hours or >10% at 4 hours is diagnostic.

High‑Yield Points - ⚡ Biggest Takeaways

• Achalasia: Bird-beak sign, impaired LES relaxation, dysphagia to solids & liquids.
• GERD: Due to transient LES relaxations; PPIs are mainstay treatment.
• Gastroparesis: Delayed gastric emptying (no obstruction), common in diabetes; causes nausea, vomiting.
• IBS: Diagnosed by Rome criteria; abdominal pain linked to defecation, altered bowel habits.
• Ogilvie's syndrome: Acute colonic pseudo-obstruction with massive dilation, no mechanical block.
• Scleroderma esophagus: Features aperistalsis and patulous LES, leading to severe reflux.