Specific Motility Disorders
Common types of Motility Disorders include the following:
Food or liquid does not move down the esophagus properly. There may be problems with the esophagus contracting, either due to muscle weakness or spasms of the esophagus. Food may also become stuck in the esophagus if the Lower Esophageal Sphincter, which connects the esophagus to the stomach, doesn’t open properly. Causes may include muscle disorders, neurological conditions, anatomic abnormalities, and post-surgical complications. Symptoms include food getting stuck, vomiting or retching, regurgitation, reflux, heartburn, or chest pain.
Gastroesophageal Reflux Disease (GERD)
GERD is technically a form of esophageal dysmotility. It is typically caused by weakness of the Lower Esophageal Sphincter, which connects the esophagus to the stomach. The sphincter may stay open, be weak, or spasm, or there may be a hiatal hernia pushing on it and weakening it. Symptoms include heartburn, spitting up, and regurgitation. Reflux is common in infants, and only becomes problematic if there are serious symptoms, such as pain, discomfort, or failure to thrive.
Gastroparesis and Delayed Gastric Emptying
Gastroparesis/Delayed Gastric Emptying (DGE) is a condition where the stomach doesn’t empty as quickly as it should. This can make reflux worse and cause non-reflux related nausea and vomiting. Children with Gastroparesis/DGE do not eat or drink large volumes and they do not act hungry.
Gastroparesis literally means paralyzed stomach, and refers to a condition when the stomach does not contract or empty properly. Food or liquid stays within the stomach and does not pass into the small intestine as it should. Delayed gastric emptying is another name for the same condition, though some doctors use gastroparesis to refer to more serious cases, and delayed gastric emptying to less serious cases of slower than normal emptying. They may be caused by weakness of the muscles, uncoordinated and spasmodic contractions of the stomach, or a problem or blockage of the Pyloric Sphincter, which connects the stomach to the small intestine. Gastroparesis is also common after illness.
Children with Gastroparesis/DGE may do better with continuous feeds, or smaller more frequent bolus feeds. Children may not tolerate larger volumes, higher caloric concentrations, and foods that are harder to digest. NJ and GJ-tubes allow infants and children allow tube feeds to bypass the stomach.
Medications are successful in a portion of children with gastroparesis/DGE. The motility benefit is often the side effect, not the medications primary function, so not all will get the motility benefit. Parents need to weigh the risks of some medications for long-term use.
The role of the small intestine is to absorb the food we eat. Intestinal Dysmotility refers to slower motility in any part of the small intestine. Typically, it occurs when contractions are weak or uncoordinated. Symptoms include discomfort, bloating, nausea, or vomiting. Children with intestinal dysmotility can have GJ-tubes that dislodge and coil back into the stomach with greater frequency. They may also have formula in the stomach when being fed into the intestines, when being fed to the intestines without the GJ or J tube being out of place. Food sitting in the intestines for longer periods of time than usual can also lead to small intestinal bacterial overgrowth (SIBO), which can cause bloating, pain, or diarrhea.
Chronic Intestinal Pseudo-Obstruction
Chronic Intestinal Pseudo-Obstruction (CIPO) is a severe form of intestinal dysmotility in which the intestine acts as if there is a physical obstruction, even though one is not present. Food and liquids may not move at all, or may only move a small amount. CIPO can “flare” meaning that it doesn’t always interfere with tube feeds. However, if a child is experiencing symptoms, it may be referred to as a “gut shut down,” and the child may need to be put on “gut rest” until motility improves. Symptoms include pain, bloating, nausea, and vomiting. Children with CIPO may receive separate G- and J-tubes or TPN (Total Parenteral Nutrition), which is IV nutrition administered via a central line.
Large Intestinal or Colonic Dysmotility
The large intestine may also be affected by weak or uncoordinated contractions, leading to colonic dysmotility. The primary symptoms include constipation, bloating, fullness, or fecal incontinence. Causes are numerous, but may include slow transit through the intestine caused by weak or uncoordinated contractions, diet, or problems with the rectum or anal sphincter.
Constipation is difficulty stooling, and typically causes hard, infrequent stools, discomfort, difficulty passing stools, bloating, or fecal incontinence. More information on constipation can be found on our Constipation page.
Dumping syndrome or rapid gastric emptying occurs when contents of the stomach empty too rapidly into the intestines, before they have been fully digested. Early dumping occurs right after a meal, and late dumping occurs an hour or more after a meal. Common symptoms include diarrhea, cramps, discomfort, sweating or flushing, dizziness, and problems with blood sugar control. The most common cause of dumping is post-surgical complications.
Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is an excess growth of bacteria in the intestine, and is more common among children who have motility issues in the stomach and small intestine. When SIBO occurs, parents report a lot of excess gas, distention and bloating that is not easily relieved by venting or continuous venting. There can also be abdominal pain and discomfort, as well as increased feed intolerance. Many times, the breath will smell foul, almost like fecal matter. SIBO can be clinically diagnosed through symptoms or through the Hydrogen Breath Test. For many it is easily treated with antibiotics, but for others it is a more recurrent issue that needs to be managed. Probiotics may be added to help combat bacterial overgrowth.