6.6 Motility Disorders of the Gastrointestinal Tract

Question 1

What is manometry? How can it be used to measure gastric motility?

Answer 1

Manometry uses pressure sensors in the GI lumen to detect contraction of the musculature (and therefore motility)

Question 2

How do we use barium to assess GI motility? What are four examples of how we can do this at different points in the gut?

Answer 2

• Radiopaque barium can be swallowed, and tracked radiologically through the gut
• We can do a barium swallow (liquid), barium meal, barium follow-through, and barium enema

Question 3

Give an example of a specific technique where we can use nuclear medicine to diagnose gastric motility disorders throughout the whole tract

Answer 3

• Scintigraphy
• Radioactively labelled foods (weak radioactivity) can be traced through the gut to gauge motility

(Scintilla = spark)

Question 4

Reflux red flags

Answer 4

• Dysphagia/odynophagia
• Bleeding signs/anaemia
• Weight loss

Question 5

Hx signs of oesophageal vs oropharyngeal dysphagia

Answer 5

Oro: right as you begin to swallow (coughing/choking)

Oesophagus: a few seconds after swallowing

Question 6

List two subdivisions of oesophageal dysphagia

Answer 6

Solids + liquids: motility problem (achalasia, hypercontractile oesophagus)

Just solids: mechanical blockage (cancer, stricture)

Question 7

Nutcracker oesophagus occurs when…

Answer 7

Oesophageal contractions are too hard.

Question 8

Oesinophilic oesophagitis is most commonly caused by…

Answer 8

Food allergy.

Question 9

What are the two most common “causes” of gastroparesis?

Answer 9

• Idiopathic (nobody knows)
• Diabetes (neuronal damage)

Question 10

List four causative pathophysiological changes that can be seen in gastroparesis

Answer 10

1. Vagus nerve damage
2. Damage to neurons within stomach wall
3. Smooth muscle atrophy
4. Interstitial cells of Cajal damaged by inflammation (time distortion)

(Either the neurons are damaged, or the muscle is weak; neuromuscular damage)

Question 11

What are some secondary causes of constipation (other than CRC)

Answer 11

• Endocrine/metabolic
• Neurologic
• Hirchsprung’s
• Medication adverse effects

Question 12

Causes of faecal incontinence?

Answer 12

• Sphincter weakness
• Neurological disorders
• Pelvic floor dysfunction
• Rectosigmoid brake failure

Question 13

Describe the concept of functional gut disorders

Answer 13

• Dysfunction of gut-brain axis
• Diagnosed based on symptom patterns

Question 14

Gastroparesis treatment

Answer 14

• Prokinetic agents
• Antiemetic agents
• Botox (removing influence of muscles that delay gastric emptying)

Question 15

Constipation treatment

Answer 15

• Non-pharm: high fibre diet, exercise, increased fluid intake
• Pharm: laxatives, enemas
• Biofeedback pelvic muscle training
• Surgery (correct damage)

(Also address any underlying cause; such as neurological cause, metabolic cause, etc.)