Disturbances in small bowel motility

doi:10.1053/bega.1999.0034

Best Practice & Research Clinical Gastroenterology

Volume 13, Issue 3, October 1999, Pages 385-395

https://doi.org/10.1053/bega.1999.0034 Get rights and content

Abstract

Recently, the small intestine has become the focus of investigation as a potential site of dysmotility in the irritable bowel syndrome (IBS). A number of motor abnormalities have been defined in some studies, and include ‘clustered’ contractions, exaggerated post-prandial motor response and disturbances in intestinal transit. The significance of these findings remains unclear. The interpretation of available studies is complicated by differences in subject selection, the direct influence of certain symptoms, such as diarrhoea and constipation, and the interference of compounding factors, such as stress and psychopathology. Dysmotility could also reflect autonomic dysfunction, disturbed CNS control and the response to heightened visceral sensation or central perception. While motor abnormalities may not explain all symptoms in IBS, sensorimotor interactions may be important in symptom pathogenesis and deserve further study.

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Cited by (28)

Clinical and Translational Aspects of Normal and Abnormal Motility in the Esophagus, Small Intestine and Colon
2018, Physiology of the Gastrointestinal Tract, Sixth Edition
Motility is the process of moving luminal contents through the gastrointestinal (GI) tract. However, motility encompasses many complex processes and is influenced by many internal and external factors. While there is intrinsic or enteric nervous system, motility is also influenced by the central nervous system and the sympathetic and parasympathetic nervous systems, by the hormonal milieu by receptors throughout the GI tract, by luminal contents and by the microbiome of the GI tract. In health, this complex integrated system works seamlessly to transport liquid, solid, and gaseous contents through the GI tract sampling the contents and adjusting transport accordingly by speeding, slowing, or stopping the flow and by increasing or decreasing pressure within the sphincters. However, these complex integrated systems are subject to acute and chronic pathophysiologic changes that can lead to short- and/or long-term dysfunction.
Rapid advances in technology have allowed the development of cutting edge diagnostic methods that can be applied to patients with functional motility disorders of the GI tract. These technologies and methods allow the clinician to investigate various aspects of motility. In this chapter, we will discuss recent diagnostic tests and cutting edge therapeutic advances aimed at diagnosing and treating functional motility disorders within the luminal GI tract of the esophagus, small intestine, and colon. The stomach will be discussed in another section.
Pathogenic Factors Involved in the Development of Irritable Bowel Syndrome: Focus on a Microbial Role
2010, Infectious Disease Clinics of North America
Citation Excerpt :
Although IBS is considered to affect mainly the large bowel, several studies have found altered motility of the small intestine, stomach, and esophagus. The most striking feature was an occurrence of repetitive bursts or clusters of contractions, which seemed to correlate with patients’ symptoms.26 However, these motor patterns are not specific to IBS and can be found in other disorders.27,28
Relationship of Abdominal Bloating to Distention in Irritable Bowel Syndrome and Effect of Bowel Habit
2006, Gastroenterology
Citation Excerpt :
A generalized retention of fluid leading to distention is unlikely because it has been shown that large volumes of ascites are needed before there is a noticeable change in girth.36 Abnormal gas, fluid, or solid handling might result from a motility disorder of the gut, although most studies to date have been unable to identify reproducible abnormalities in either small- or large-bowel motor activity under normal physiologic conditions37,38 or during infusion of intestinal gas39 in patients with IBS compared with healthy volunteers. However, it is conceivable that any motor dysfunction could be localized or transient, making it almost impossible to detect using standard manometry.
Background & Aims: The relationship between the sensation of bloating, often ranked as the most bothersome symptom by patients with irritable bowel syndrome (IBS), and actual distention manifest as an increase in abdominal girth is controversial. Investigation of this problem has been hampered by the lack of a reliable ambulatory technique to measure abdominal girth. The aim of this study was to use the technique of abdominal inductance plethysmography to compare diurnal variation in girth in IBS patients and healthy volunteers, relating these changes to the sensation of bloating. Methods: Abdominal girth was recorded for 24 hours in 20 IBS-constipation (age, 18–73 y), 20 IBS-diarrhea (age, 25–62 y) and 10 IBS-alternating (age, 21–59 y) female patients meeting Rome II criteria and 20 healthy female controls (age, 18–67 y). All subjects pursued normal daily activities, recording their symptoms of bloating and pain together with bowel habit. Results: All patients with IBS, irrespective of bowel habit, reported significantly greater bloating than controls (P < .0001). Forty-eight percent of patients also showed distention beyond the 90% control range, with this being most prominent in IBS-constipation. Bloating correlated strongly only with distention in IBS-constipation (r ≥ 0.48; P ≤ .02). Neither bloating nor distention in IBS was related to body mass index, age, parity, or psychologic status. Conclusions: Abdominal distention is a clearly definable phenomenon in IBS that can reach 12 cm. However, it only occurs in half of patients reporting bloating, and the 2 only correlate in IBS-constipation. Bloating and tentiodisn may differ pathophysiologically and this appears to be reflected in the bowel habit subtype.
Altered 5-hydroxytryptamine signaling in patients with constipation- and diarrhea-predominant irritable bowel syndrome
2006, Gastroenterology
Evidence suggests that postprandial platelet-depleted plasma 5-hydroxytryptamine (5-HT) concentrations may be abnormal in irritable bowel syndrome (IBS). However, interpretation of the data has been hampered by the variable methodology and rather small numbers used in previous studies. Therefore, the aim of this study was to measure concentrations of platelet-depleted plasma 5-HT and its metabolite 5-HIAA under fasting and fed conditions in a large group of patients with diarrhea-predominant (d-) and constipation-predominant (c-) IBS, compared with controls. The ratio of plasma 5-HIAA:5-HT and platelet stores was also assessed.
Twenty-nine c-IBS patients (aged, 19–53 years), 55 d-IBS patients (aged, 19–52 years), and 35 healthy volunteers (aged, 18–46 years) had platelet-depleted plasma 5-HT/5-HIAA concentrations measured using reverse-phase, high-performance liquid chromatography with fluorimetric detection before and after a standard meal.
d-IBS patients had raised platelet-depleted plasma 5-HT concentrations under fasting and fed conditions (P < .05). However, the postprandial relative to fasting concentration was similar to controls. In contrast, c-IBS patients failed to show an increase in platelet-depleted plasma 5-HT concentration with meal ingestion compared with controls (P < .01). c-IBS was associated with decreased 5-HIAA (P < .01) but normal 5-HIAA:5-HT ratio and d-IBS with normal 5-HIAA concentrations but reduced 5-HIAA:5-HT ratio (P < .005). C-IBS but not d-IBS patients had increased platelet 5-HT.
These results support the concept that d-IBS is characterized by reduced 5-HT reuptake, whereas impaired release may be a feature of c-IBS. These results also provide a rational basis for current pharmacologic approaches involving modulation of different 5-HT receptors in c- and d-IBS.
Disturbances of motility and visceral hypersensitivity in irritable bowel syndrome: Biological markers or epiphenomenon
2005, Gastroenterology Clinics of North America
Citation Excerpt :
Indeed, in some of these studies, the appearance of clusters in the jejunum was accompanied by the onset of the patient's typical symptoms [17,19]. Clusters are not diagnostic of IBS; they are a feature of several motor disorders [10,16]. Furthermore, several other investigators have failed to demonstrate an increased prevalence of clusters among their IBS patients [20–24].
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2018, Sensors (Switzerland)

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^f1: All correspondence to: Professor Eamonn M. M. Quigley, Department of Medicine, National University of Ireland, Cork, Clinical Sciences Building, Cork University Hospital, Cork, Ireland

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Regular ArticleDisturbances in small bowel motility

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Regular Article
Disturbances in small bowel motility