Conditions and Treatments
Types of Motility Conditions
Motility disorders interrupt the body’s ability to move food and nutrition through the gastrointestinal system. Also known as dysmotility, these disorders can cause a range of health problems, often based on the affected organ(s).
Acid reflux or gastroesophageal reflux disease (GERD): Acid reflux is when the acid that is normally in your stomach backs up into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. When the acid reflux occurs frequently, it can cause GERD.
The most common symptoms are:
- Heartburn, which is a burning feeling in the chest
- Regurgitation, which is when acid and undigested food flow back into your throat or mouth
Other symptoms might include:
- Stomach or chest pain
- Trouble swallowing
- Having a raspy voice or a sore throat
- Unexplained cough
- Nausea or vomiting
Dysphagia: Dysphagia is the medical term for "trouble swallowing." Sometimes, dysphagia happens if you eat too fast or don't chew your food well enough. But if you have dysphagia, you might have a serious medical problem that needs to be treated right away.
The symptoms include:
- Not being able to swallow
- Pain while swallowing
- Feeling like food is stuck in your throat or chest
- Coughing or gagging while swallowing
- Drooling
- Trouble speaking
Achalasia:
Achalasia is a condition that affects the esophagus. At the lower end of the esophagus, where it connects to the stomach, there is a muscle called the lower esophageal sphincter (LES). When the LES tightens, food can't move from the esophagus into the stomach. When the LES relaxes, food can move from the esophagus into the stomach.
When a person has achalasia:
- The lower part of the esophagus does not work normally
- The LES doesn't relax, so food can't move into the stomach
The most common symptom of achalasia is trouble swallowing foods and drinks.
Other symptoms can include:
- Chest pain
- Vomiting
- Heartburn
- Feeling like you have a lump in your throat
- Losing weight without trying
Non-cardiac chest pain: Painful squeezing or tightness in the chest behind the breastbone (the sternum). Chest pain can be dangerous and can lead to heart attack if it is from the heart origin (cardiac chest pain). Therefore, cardiac chest pain should be ruled out first by your heart doctor. Esophageal chest pain, (non-cardiac chest pain) is the second most common cause of chest pain, after musculoskeletal origin. This condition can be seen in GERD or problem of contracting esophageal muscles.
Diffuse esophageal spasm: The flow of food to your stomach requires the coordinated efforts of muscles in your esophagus. This condition interrupts that coordination and prevents food from being pushed into the stomach. This condition can lead to achalasia. Symptoms include:
- Chest pain
- Difficulty swallowing
- Feeling like food is stuck in the chest
- Heartburn
- Regurgitation
Jackhammer esophagus: With this condition, the muscles in the esophagus contract with too much force. Symptoms include:
- Chest pain
- Difficulty swallowing
- Feeling like food is stuck in the chest
- Heartburn
- Regurgitation
Nausea and vomiting: Nausea and vomiting are symptoms of a wide range of diseases and disorders. Unexplained vomiting or nausea might prompt your doctor to suggest tests that could point to a motility disorder.
Belching and hiccups: Everyone experiences belching and hiccups from time to time. But when they become frequent or troublesome, they may indicate the presence of a motility disorder.
Gastroparesis:
Gastroparesis is a condition that causes nausea and vomiting. It can also make you feel full too soon after you start eating. It happens because the stomach takes too long to empty and does not move food along through your body fast enough. Gastroparesis is also called "delayed gastric emptying." ("Gastric" means "having to do with the stomach." “Paresis” means “paralyzed”.)
Gastroparesis is a common problem among people with diabetes. It also can happen to people who have had food poisoning (gastroenteritis). But it can sometimes happen to people who have not been sick and who do not have diabetes.
When gastroparesis starts after someone has had food poisoning, it often gets better in a few days to weeks. Sometimes, it lasts longer or never goes away. In people with diabetes, it usually does not go away, but there are things that can make it better.
The symptoms can include:
- Nausea with or without vomiting
- Belly pain
- Feeling full too soon after you start eating
- Bloating (feeling as though your stomach is full of air)
- Weight loss
Functional dyspepsia (indigestion): Functional dyspepsia is the medical term for a condition that causes an upset stomach or pain or discomfort in the upper belly, near the ribs. The most common symptoms of functional dyspepsia include:
- Upset stomach
- Discomfort or pain in the belly
- Bloating
- Feeling full quickly when eating
Some people also have nausea, vomiting, a lack of appetite or weight loss. Functional dyspepsia can be overlapped with gastroparesis.
Cyclic vomiting syndrome: Cyclic vomiting syndrome (CVS) is an idiopathic disorder characterized by recurrent, stereotypical bouts of vomiting with intervening periods of normal or baseline health. Both children and adults are affected, although the clinical presentation and natural history vary somewhat with age. The key features are:
- Recurrent discrete episodes of vomiting
- Varying intervals of normal health between episodes
- Episodes are stereotypical regarding timing of onset, symptoms and duration
- The vomiting is not attributable to other disorders
Carbohydrate intolerance: Carbohydrate intolerance is the small intestine’s inability to adequately process some carbohydrates found in food. Carbohydrates come in different forms, each requiring different enzymes to process. As such, intolerance comes in several forms.
Lactose intolerance is the most common, with the small intestine lacking the enzymes needed to digest sugar found in milk.
Fructose intolerance occurs when the small intestine lacks the enzymes needed to digest fructose, a form of sugar found in fruit, honey and some vegetables.
Symptoms include:
- Nausea
- Cramps
- Bloating
- Diarrhea
- Flatulence
Small intestinal bacterial overgrowth (SIBO): Small intestinal bacterial overgrowth (SIBO) is a condition in which colonic bacteria are seen in excess in the small intestine. When present, this overabundance of organisms can result in intestinal symptoms and, in extreme cases, malabsorption. Symptoms may include:
- Bloating
- Nausea
- Diarrhea
- Abdominal pain
- Malnutrition in severe cases
Bloating: When your stomach is bloated, it feels tight, full and possibly in pain. The bloating may be accompanied by a swelling abdomen. It is usually a digestive issue and, in some cases, could point to a motility disorder.
Chronic intestinal pseudo-obstruction: Pseudo-obstruction is characterized by signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of an anatomic lesion that obstructs the flow of intestinal contents, and the presence of dilation of the bowel on imaging:
- Bloated belly
- Vomiting
- Constipation
- Diarrhea
- Belly distention
Irritable bowel syndrome (IBS): This disorder affects the lower gastrointestinal tract. With IBS, the colon looks normal but does not work the way it should. It is a long-term chronic condition for which there is no known cause. Symptoms include:
- Belly pain
- Painful constipation or diarrhea
- Mucus in the stool
- Alternating episodes of constipation and diarrhea
Chronic idiopathic constipation: Constipation occurs when your stool is painful and infrequent (less than three times a week). It is the most common gastrointestinal problem. It can be caused by a range of factors, including not getting enough exercise, not eating enough fiber, medication and not drinking enough fluids. But there are times when there is no clear cause. Symptoms include:
- Difficult or incomplete evacuation of stool
- Feeling bloated
- Abdominal pain or discomfort
- Ineffective straining to move your bowels
Dyssynergic defecation: This is a type of pelvic floor disorder that makes it hard to defecate and can lead to chronic constipation. The pelvic floor is the group of muscles in the pelvis that controls bowel movements. When those muscles and nerves aren’t working correctly, stool cannot be released. Symptoms include:
- Excessive straining while passing stool
- Hard stool
- Need to pull stool out with fingers or push to the bottom to let the stool out
Fecal incontinence: Fecal incontinence is the medical term for when a person loses control of their bowels. A person with fecal incontinence might leak solid or liquid bowel movements. The term "anal incontinence" includes these issues as well as the leaking of gas.
Fecal incontinence is most common in people who gave birth to one or more babies when they were younger. It happens because the muscles that control bowel movements can get damaged in childbirth. People can also have fecal incontinence for other reasons.
Having fecal incontinence can be embarrassing and stressful. People who have it sometimes stay at home instead of going out, because they are afraid of having "an accident." If you have trouble controlling your bowels, you should know that the problem is not a normal part of aging. It can often be treated and fixed, or at least improved.
Diagnosis
At the Orlando Health Digestive Health Institute Motility Center, our first objective is to identify your motility disorder and its source. We provide a wide range of innovative diagnostic tools and tests. Among them is a single-use capsule, which once swallowed, will provide a simple and painless way to collect data on your gastrointestinal system.
The tiny pill-shaped sensor travels through your digestive tract, collecting and sending data as it goes. Among other things, it measures acid levels, temperature and pressure levels over the three to five days it takes to exit your body.
Other tests may be recommended, based on which part of your digestive system is affected.
Wireless esophageal pH test: A small capsule is placed in your esophagus, where it transmits data about acid levels for up to 96 hours. During that time, you will eat and drink as normal. The test is used to diagnose gastroesophageal reflux disease.
Wire-based esophageal pH test with impedance: A thin catheter is run through your nasal passage and then swallowed down the esophagus. You will eat and drink as normal over a 24-hour period, while the catheter measures acid levels in your esophagus.
Esophageal manometry: This test uses a thin, flexible tube inserted through your esophagus and into your stomach. It is lined with pressure sensors that help evaluate whether the muscles in your esophagus are working correctly. It can be used to diagnose conditions such as diffuse esophageal spasm and achalasia.
Impedance planimetry: A balloon-like sensor, filled with special fluid, is inserted into the esophagus, where it measures pressure within the organ. This minimally invasive procedure is used to help diagnose a range of conditions, including achalasia and dysphagia.
Gastric emptying study: This test measures the amount of time it takes for a meal to leave your stomach. You will be asked to eat a small meal, which is laced with a harmless radioactive isotope. It allows the radiologist to track the meal through a series of images of your stomach.
Pyloric: The procedure uses a balloon-like sensor to measure pressure inside the stomach to evaluate the pyloric sphincter, the muscle that connects the stomach with the small intestine. It is used to help diagnose gastroparesis.
Hydrogen breath test: Breath samples are tested to look for bacterial overgrowth, or intolerance to lactose, fructose or disaccharide.
Anorectal manometry: A thin flexible probe is inserted through the anus and into the rectum. At the tip of the tube is a small balloon that is gradually inflated. The test measures contractions and relaxations of the rectum and anal sphincter. The test is commonly used for people with constipation and fecal incontinence.
Defecography: This test is used to investigate issues with stool movement. A barium paste, with the consistency of poop, is inserted into your rectum. Then you pass the substance while sitting on a special toilet inside a scanning machine. The radiologist will use X-ray or magnetic resonance imaging (MRI) to see what’s happening inside your body.
Biofeedback therapy: The test uses electrodes, a computer and a pressure device to look for areas of the digestive system that aren’t working properly. It can help diagnose dyssynergic defecation and fecal incontinence.
Endoanal ultrasound: A small probe is inserted into the anus. The probe sends out sound waves that bounce off internal organs to help create images of the rectum and surrounding tissue.
Treatments
The specialists at the Orlando Health Digestive Health Institute Motility Center offer the latest treatments available, with an emphasis on nonsurgical options whenever possible. Symptoms often can be managed through medication and lifestyle changes. We also perform interventional endoscopy procedures, working with the Orlando Health Digestive Health Institute’s Center for Advanced Endoscopy, Research and Education, along with Orlando Health’s thoracic and colorectal surgeons.
Among the treatments we provide:
This procedure uses a specialized balloon that is inserted into the esophagus, where it is inflated. This relaxes the sphincter that is restricting the flow of food to your stomach. You may need several treatments, and the procedure may need to be repeated every few years.
An endoscopic tube is inserted into the esophagus, where it expands a balloon to stretch muscle fibers in the lower esophageal sphincter. This is a treatment option for patients with achalasia.
This is an option for patients who do not want, or cannot have, a minimally invasive procedure like sphincter dilation. Botox is injected into the esophagus, where it helps to relax the muscles interfering with the flow of food.
A thin, flexible endoscope is inserted through the mouth and into the esophagus, where it is used to make a series of cuts in the muscles. This loosens them and prevents them from interfering with swallowing. The procedure is done under general anesthesia and takes about an hour.
This procedure is similar to POEM, but it is performed through laparoscopy – with several small incisions made in your abdomen to provide access to your esophagus. Using a camera, the surgeon makes a series of cuts in muscle tissue in the esophagus. The procedure is done under general anesthesia and requires an overnight stay at the hospital.
This minimally invasive procedure uses an endoscope to reach the sphincter that controls the flow of food from your stomach to your small intestine. A series of small cuts near this pyloric sphincter help to relax it permanently.
During this surgery, the upper stomach is wrapped around the lower part of the esophagus. The goal is to reduce the amount of acid reflux flowing back into the esophagus. The procedure, done under general anesthesia, requires a wide incision in your abdomen. You can expect to be hospitalized for two to four days after the surgery.
This minimally invasive procedure uses a tiny bracelet of magnetic titanium beads to surround the lower esophageal sphincter. The magnetic properties of the beads keep the sphincter closed (except when you are swallowing) and prevent acid from flowing back into the esophagus. The laparoscopic procedure, which takes less than an hour, is performed under general anesthesia and usually requires an overnight hospital stay.
This device is used to flush water into the bowel through the rectum while sitting on a toilet. The water helps flush the lower colon. The system gives you greater control over your bowel movements, helping with fecal incontinence and constipation.
A small transmitter is placed under the skin in the upper buttock. It sends gentle electric impulses through a thin wire placed near the sacral nerve. It functions like a pacemaker for the heart, except that it stimulates the bladder, sphincter and bowel muscles to work properly. The device is put in place during two separate out-patient procedures.