Gastrointestinal Motility

Including Gastroparesis, Eosinophilic Esophagitis (EoE), and Refractory Gastroesophageal Reflux Disease (GERD)

Summary:
Gastrointestinal (GI) motility refers to the movements of the digestive system, and the transit of the contents within it. When any portion of the digestive tract does not function as it should, a person develops symptoms related to a GI motility disorder.

Common GI motility conditions include: gastroparesis, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD).

Overview

  • Gastroparesis, a disorder characterized by delayed stomach emptying in the absence of any obstruction, affects up to 15 million Americans.
  • Gastroparesis has been reported in up to 50% of people with type-1 diabetes and up to 20% of people with type-2 diabetes.
  • Eosinophilic esophagitis (EoE) is an emerging allergic/immune condition characterized by inflammation or swelling of the esophagus.
  • People with refractory gastroesophageal reflux disease (GERD) continue to have symptoms of GERD despite standard treatment with proton pump inhibitors (PPIs).
  • Refractory GERD may affect up to 40% of patients who use a once-daily PPI.

Natural History

  • Mild symptoms of gastroparesis can usually be managed with dietary and lifestyle measures while moderate-to-severe symptoms may require treatment with prokinetic agents. Severe symptoms may call for enteral or parenteral nutrition, gastric electrical stimulation, or other surgical procedures.
  • Food allergies are the main cause of EoE in children. When allergenic foods are removed from a person’s diet, symptoms can resolve and inflammation in the esophagus can be healed.
  • GERD can damage esophageal tissue, although in approximately 50-70% of people with GERD, no such damage is present.

Etiology and Disease Pathogenesis

  • In most people with gastroparesis, the cause is unknown. Diabetes is the most common known cause of gastroparesis.
  • Gastroparesis most often occurs when the nerves to the stomach are damaged or don't work properly. Gastroparesis can also occur after stomach surgery for other conditions.
  • In EoE, large numbers of eosinophils (a type of white blood cell) are found in the tissue of the esophagus.
  • There is no known single cause of GERD. Refractory GERD may be caused by anatomical factors, such as a weak lower esophageal sphincter, the presence of a hiatal hernia, or hypersensitivity to physiologic amounts of acid reflux.

Identifying Patients

  • Gastroparesis is diagnosed through a physical exam and a test such as an upper endoscopy, upper GI series, or a radioisotope gastric emptying scan.
  • Currently, the only way to diagnose EoE is with an endoscopy and biopsy of the esophagus.
  • Diagnostic evaluation for refractory GERD should be considered after evaluation for proper compliance with PPI therapy. Patients who fail a PPI should undergo either an upper endoscopy or esophageal pH testing.

Symptoms

  • Symptoms of gastroparesis usually occur during and after eating a meal. Typical symptoms include nausea, vomiting, retching, stomach fullness following a normal-sized meal, and satiety (early fullness). Bloating, heartburn, and stomach discomfort or pain may also occur.
  • The symptoms of EoE vary with age. Infants and toddlers may refuse their food. School-age children often have recurring abdominal pain, trouble swallowing, or vomiting. Teenagers and adults most often have difficulty swallowing due to food impaction (a medical emergency involving the narrowing of the esophagus to the point where food gets stuck).
  • The two most frequently reported symptoms of GERD are heartburn and acid regurgitation. Some people with GERD may experience a cough, asthma, laryngitis, or chest pain, while others may have no symptoms at all.

Potential Complications of GI Motility

Complications of gastroparesis include:

  • Bacterial overgrowth in the stomach.
  • Bezoars—solid masses in the GI system that may cause nausea, vomiting, and obstruction in the stomach.

Complications of EoE include:

  • Irreversible structural alterations of the esophagus, which can lead to:
    • Tissue fibrosis.
    • Stricture formation—narrowing of the esophagus.
    • Impaired function.

Complications of GERD include:

  • Stricture formation—narrowing of the esophagus.
  • Esophageal ulcer—an open sore in the esophagus.
  • Barrett’s esophagus—precancerous changes to the esophagus.

GI Motility Resources for In-depth Information