What are motility disorders?

Related links:

• Our services: How we care for children with motility disorders

Related tests and treatments:

• Esophageal dilation
• Gastric emptying study
• Gastric pacing
• Manometry
• 24-hour pH impedance probe test
• Sitzmark colon transit test
• Surgery
• Upper GI series
• Upper endoscopy (EGD)
• Colonoscopy

About motility disorders

A motility disorder is a condition where the nerves and muscles in the gastrointestinal tract are not working together correctly, which causes difficulty in the digestive process. These conditions include chronic intractable constipation,  gastroesophageal reflux disease (GERD), chronic intestinal pseudo-obstruction, gastroparesis, Hirshsprung’s disease, and esophageal achalasia, among other disorders.

What causes motility disorders?

Motility disorders stem from problems with nerves in the GI tract, intestinal muscles or how the two work together. Sometimes problems with the autonomic nervous system, which helps regulate the GI tract, can also present like motility disorders. In many cases doctors don’t know what causes a motility problem.

How often do motility disorders occur?

Some motility disorders can mimic GI functional disorders, which are relatively common in children. For example, functional constipation affects 16 percent of children. Other motility disorders are rare: For example, Hirshsprung’s disease affects 1 in 5,000 children, and esophageal achalasia affects only 1 in 1 million children.

How do motility disorders develop?

A motility disorder can start at birth if the nerves in the GI tract don’t develop properly inside the mother’s womb. These conditions can also come on later in life, especially after an inflammatory or infectious insult to the GI tract, such as a stomach bug.

What are the symptoms of motility disorders?

Symptoms can vary depending on the part of the GI tract that is affected, but they can include:

• Constipation (two or fewer bowel movements per week)
• Fecal soiling
• Swollen stomach
• Gassiness
• Chronic abdominal pain or discomfort
• Episodic stomach swelling and pain
• Nausea or vomiting
• Reflux
• Diarrhea
• Problems swallowing

Who is at risk of developing this condition?

Children with certain genetic disorders, syndromes such as Trisomy 21, or children with autonomic disorders can be more prone to motility disorders. Children with developmental delays, autism and attention deficits are also at higher risk of motility disorders such as severe constipation and soiling. However, motility problems can affect anyone whose GI tract has suffered from an inflammatory or infectious insult.

Why are motility disorders a concern?

These disorders can compromise GI function to the point where it adversely affects a child’s quality of life. In extreme cases, the symptoms could be so debilitating that a child is unable to eat or pass stool, causing severe weight loss.

How are motility disorders diagnosed/evaluated?

In addition to imaging studies, these conditions are usually evaluated with manometry studies, which measure the pressure in different areas of the gastrointestinal tract. These tests are only done at very specialized centers, including Children’s Wisconsin. Before manometry, your child’s doctor might recommend less invasive tests, such as an upper GI series, gastric emptying study and Sitzmark colon transit test. If reflux is suspected, your child’s doctor might order a 24-hour pH impedance probe test.

What is the treatment for motility disorders?

Treatment depends on your child’s particular diagnosis. If the problem is chronic intractable constipation, treatment could involve simple lifestyle changes, such as eating a lot of high-fiber foods, drinking plenty of water, using consistent toileting routines and getting regular exercise. Laxatives are also recommended to help ensure regular bowel movements. If these treatments don’t work, your child’s doctor may need to place a cecostomy tube in your child’s large bowel to flush out the stool. Some children can benefit from a large bowel pacemaker called sacral neuromodulation or InterStim therapy.

Children with gastroparesis might need to eat smaller, more frequent meals and avoid high-fat and high-fiber foods. Some children need a gastrostomy to drip food directly into the stomach and to decompress the stomach. Gastric pacing, which involves surgically placing a pacemaker in the stomach that changes nerve transmission between the gut and brain, is sometimes used to treat gastroparesis and chronic nausea and vomiting. Our motility specialists might also suggest your child see a psychologist for cognitive behavior therapy and/or biofeedback, both of which can be helpful in coping with the symptoms of chronic illness.

What happens after treatment?

We follow patients long-term to evaluate their progress. With patients from outside of Wisconsin or the United States, we partner with our patients’ local GI physicians to optimize care.

When should you contact a physician?

If your child suffers from the symptoms discussed above, talk to his or her pediatrician and/or regular GI doctor to see whether your child’s symptoms warrant evaluation by a motility specialist.

What is the long-term outlook for motility disorders?

Outcomes vary by condition. Some patients improve over time and do very well with medication or other treatments, while more severe or complex cases could require pacemakers or surgical intervention.

How do I live with motility disorders?

Our specialists will provide the support you need so your child can live as normal of a life as possible. It’s important to stay active and continue regular activities and involvement with peers.

For more information about motility disorders, visit the International Foundation for Functional Gastrointestinal Disorders.