Clinical Manifestations of Severe Gastrointestinal Motility Disturbance

Abstract

Severe gastrointestinal motility disturbance, or pseu doobstruction, can cause symptoms and signs that mimic mechanical bowel obstruction in patients. The symptoms depend on the parts of the gastrointestinal tract involved. Patients may have dysphagia with esoph ageal involvement, gastroparesis with stomach involve ment, intestinal pseudoobstruction with small bowel in volvement, or colonic pseudoobstruction with colonic involvement. Patients often have involvement of more than one part of the gastrointestinal tract. Gastrointesti nal motility abnormality can be the result of diseases that cause either smooth muscle or myenteric plexus abnormalities and dysfunction. It is important to locate the dysfunctional segment of the bowel so that proper treatment can be initiated. The incidence of severe gas trointestinal motility disturbance is not known, but it is probably more common than has been recognized. Me chanical obstruction of the bowel is much more com mon than pseudoobstruction; therefore, it must be ruled out before a diagnosis of pseudoobstruction is made. Gastrointestinal contents are moved along the di gestive tract as a result of normal coordinated pro pulsion of its wall. Abnormal gastrointestinal motil ity from either hypoactivity or uncoordinated hyperactivity causes ineffective propulsion and re tention of the contents in the defective organ. Ob structive symptoms of the defective organ will de velop in patients with severe gastrointestinal motility disturbance. Table 1 lists these manifesta tions. They may occur individually or in combi nation, depending on the diseases that cause the abnormal motility. In this review we discuss pathophysiology, causes, clinical manifestations, diagnosis, and treatment of these problems.