Diagnosing gastrointestinal motility disorders can prove to be a clinical conundrum for practitioners. Many of these conditions have symptoms that overlap, and the initial investigation, such as an X-ray, does not always provide clear-cut answers. Patients often struggle for some time before their conventional doctors have answers to their suffering.
Collaborating with an integrative healthcare practitioner can offer valuable insights into some chronic gastrointestinal motility disorders like GERD and SIBO. This article breaks down the key differences between the various disorders, functional medicine tests that can be utilized, and options to support your gut motility holistically.
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What Are Gastrointestinal Motility Disorders?
The gastrointestinal tract has a motor system that propels food and feces through the length of the digestive tract. The enteric nervous system (ENS) controls the motor system, an autonomic nervous system component. Diseases, dysfunction, and disturbances can affect the function of the ENS, leading to disruption in gastrointestinal motility. This leads to abnormal peristalsis and gut sensitivity from the esophagus to the rectum. Common conditions that lead to motility issues are divided into upper or lower gastrointestinal motility disorders.
What Are The Different Types of Gastrointestinal Motility Disorders?
Here is a list of common motility disorders of the digestive system.
1. Gastrointestinal Reflux Disease (GERD)
GERD is a persistent occurrence of reflux of stomach content back up into the esophagus. This can result in symptoms of pain, burning, and inflammation within the digestive tract. Relaxation of the lower esophageal sphincter is the primary cause of GERD and what makes this fall into a dysmotility category.
2. Achalasia
Achalasia is a swallowing disorder where impairment of the esophagus muscles is the primary concern. This condition prevents food from traveling down the throat to the stomach. Research indicates that the problem may involve degeneration of the nerve cells within layers of the esophageal muscles. These nerves allow for the contraction and propulsion of food through the esophagus.
3. Eosinophilic Esophagitis
The symptoms of eosinophilic esophagitis are much like achalasia. The culprit in this condition is due to an immune system disorder, where the white blood cells, eosinophils, infiltrate the esophagus. This causes irritation, inflammation, and leads to issues with swallowing food.
In this condition, the upper and lower esophageal sphincters can be mechanically damaged, contributing to eating problems. Various factors, including genetics, food allergies or sensitivities, and environmental exposures, can affect this immune-activated condition.
4. Biliary Dyskinesia
Biliary dyskinesia is a functional gallbladder disorder in which the gallbladder does not contract and empty well. This inhibits the bile from moving out of the gallbladder, an essential component of digestive processes. It’s unclear what causes this condition, but it is thought to be an impairment in nerves, such as the vagus nerve, that would generally assist in contracting this organ.
5. Gastroparesis
This gastrointestinal motility condition affects the motor function of the stomach muscles. Much like the other organs mentioned above, innervation to the stomach is not working correctly. It causes gastroparesis or “paralysis of the stomach.” There is a lack of contraction, which prohibits the stomach from moving food and contents to the next stage of digestion.
In these conditions, patients have delayed gastric emptying, leading to abdominal pain, bloating, malnutrition, weight loss, heartburn, nausea, and vomiting.
6. Chronic Intractable Constipation
Having occasional or situational constipation is different from chronic intractable constipation. The stark difference is that intractable constipation does not typically respond to laxatives or lifestyle changes. This is because their intestinal lining has impaired transit time or dyssynergia with poor coordination of stool expulsion through the intestines. This can be an acquired condition but is also a result of genetic factors and other GI disorders.
7. Hirschsprung’s disease
Hirschsprung’s disease (HD) is a congenital condition resulting from missing motor complexes within the GI tract. This includes the absence of ganglion cells, Meissner plexus, and Auerbach’s plexus. This is usually diagnosed in infancy due to chronic constipation or obstruction. The sigmoid colon is the most impacted area in this disease.
Early intervention through a “pull through” surgical procedure entails resectioning the last part of the affected sigmoid colon. There, they excise the damaged area of the colon and connect the thriving ganglionic present colon to the rectum. Regarding motility disorders, HD is one of the most severe conditions and needs urgent attention.
8. Small Intestinal Bacterial Overgrowth (SIBO)
One distinctive gastrointestinal condition is SIBO. This can occur when the small intestines become overpopulated with opportunistic bacteria species. It causes distress and inflammation to the GI tract, leaving people with maldigestion and malabsorption complications.
The migratory motor complex is within the small intestine and is responsible for contracting the intestinal lumen, moving food through to the large intestine. Food and debris can only move through their intended route when this process is working correctly. Bacteria in the large intestine can also travel back up to the small intestine, causing displacement in the microbiome. Displaced bacteria in the small intestine will then increase, leading to the symptoms of SIBO.
9. Irritable Bowel Syndrome (IBS)
The pathophysiology of IBS reveals that it is both a syndrome of gastrointestinal sensitivity and a GI motor disturbance. This usually presents as slow motility in the colon, leading to constipation in those with IBS-C, one variation of irritable bowel syndrome.
What Are The Signs and Symptoms of Gastrointestinal Motility Disorders?
Signs and symptoms can vary based on the affected area of the digestive tract. Here are some of the overlapping and common symptom presentations.
- Difficulty or pain upon swallowing
- Heartburn like acid reflux or unexplained chest pain
- Gas
- Bloating
- Burping
- Unexplained nausea or vomiting
- Constipation or diarrhea
- Pain or discomfort in the abdomen or anus
- Bleeding or pain when passing stool
- Mucus and stool discharge from the anus
What Are The Possible Causes of Gastrointestinal Motility Disorders?
Not all motility disorders have the same root cause. There are similarities in terms of genetic predisposition, but different environmental factors can influence the development of each disorder. While impaired motility is a culprit to the dysfunction, many times, there are acquired factors to consider.
Understanding each condition will help point you in the right direction as to what’s causing your motility impairment. Some acquired factors to consider are pathogenic microorganisms, enteric nervous system dysregulation, altered gut-brain axis, autoimmunity, and lifestyle factors like stress, diet, chronic inflammation, and autoimmunity.
Functional Medicine Labs to Test for Root Cause of Gastrointestinal Motility Disorders
Investigating the inherited and acquired causes of gastrointestinal motility disorders can assist you and your medical team in formulating the most comprehensive care. Here is a list of functional medicine tests to consider when assessing your condition's root cause.
Comprehensive Stool Test
Looking at overall microbiome status can provide valuable insight. The GI-MAP + Zonulin test by Diagnostic Solutions is a thorough stool analysis that looks at the components of your microbiome. Results will reveal if there are any pathogenic organisms, what your healthy microbial presence looks like, how well you are breaking down nutrients, and if inflammation is present.
This investigation benefits cases of IBS, GERD, constipation, SIBO, and gastroparesis. If eosinophilic esophagitis is under investigation, GI Effects comprehensive stool analysis would be a better option. This test is similar to the Gut Zoomers but also measures eosinophil protein X, which can increase with eosinophil activity.
SIBO Breath Test
Investigating SIBO for the root cause of your motility disorder may be warranted if you have bloating, gas, belching, and epigastric pain symptoms. Unwanted bacterial species in the small intestines can produce excess hydrogen or methane gases. A 3-hour Breath Test involves capturing your breath in provided collection bags at specific intervals over three hours.
Autoimmunity Screening
Testing for the presence of autoimmunity can rule out whether or not it is playing a role in your condition. A simple ANA can be measured, or an Autoimmune Analyzer test, which is a comprehensive evaluation of both ANA and specific autoimmune disease markers.
Food Allergies and Sensitivities
Two kinds of immune responses can happen to offending food. The first is an outright food allergy, an acute IgE immune reaction. The other is a delayed hypersensitivity reaction, which is an IgG food reaction. Both can be tested for, looking for responses to typical food antigens. LRA Food Block 238 by ELISA/ACT Biotechnologies offers food sensitivity and allergy testing. This test can determine if food interactions are causing inflammation and distress to the GI tract.
Cortisol
Stress can be a key factor in dysregulation of the nervous system. Since motor complexes need intervention from the autonomic nervous system, being chronically stressed can significantly develop your condition. Measuring Salivary Cortisol can provide a daily representation of how your body is secreting cortisol, an objective measurement of your body’s stress response.
Additional Labs To Test
Imaging tests are often the first line of investigation with a differential diagnosis of gastrointestinal motility disorders. X-ray, MRI, and CAT scans can reveal if there is inflammation within the gastrointestinal tract or narrowing of the lumen. Often, an endoscopy and/or a colonoscopy will be done to get a clear visualization of your intestinal tract. If further investigation is necessary, a GI specialist may request an esophageal manometry test, a functional MRI, an anorectal manometry test, or a bowel transit study.
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Conventional Treatment for Gastrointestinal Motility Disorders
These cases will often be referred to a gastrointestinal specialist to manage your care. Standard-of-care options include surgery for conditions like Hishsprung’s disease, medications to treat the symptoms, or standard diet modifications like increasing fiber.
Functional Medicine Treatment for Gastrointestinal Motility Disorders
Addressing the root cause and providing symptom relief are both components of functional medicine care. Ensuring the patient can function in their daily life while also addressing the main issues can bring about an optimistic outlook for those suffering from gut motility disorders. Here are some integrative medicine options to consider.
Dietary Tips to Help Manage Gastrointestinal Motility Disorders
There are a variety of dietary regimens you could implement depending on your specific motility disorder. Those with low peristalsis should maintain an anti-inflammatory diet and drink plenty of water. There is some evidence that specific “healthy” food categories can cause more damage than good regarding GI motility disorder.
For example, in gastroparesis, you should limit your intake of fatty and fibrous foods. If it is determined that you have SIBO and Low FODMAP, diet may be a therapeutic intervention to execute with the help of a practitioner. This diet requires you to reduce or eliminate foods that are high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. This includes foods like sauerkraut, many grains, dairy products, some fruits like apples, and artificial sweeteners.
Those with GERD, IBS, or Eosinophilic Esophagitis may benefit from an individualized elimination diet, avoiding spicy foods and their food sensitivities.
Natural Remedies For Improving Gut Motility
Natural remedies can be beneficial for many people with certain GI conditions, but they may not be appropriate or effective for all cases. Individuals with severe or chronic GI conditions should consult with a healthcare provider, preferably one trained in functional medicine, to determine the most appropriate treatment approach. This may include a combination of natural remedies and conventional treatments.
Botanical Stimulant Laxatives
Three botanicals are well known for their stimulant laxative properties. These are, Senna, Cascara Sagrada and Aloe. These each have anthraquinone qualities, containing glycosides that can activate the intestines' myenteric plexus (motor complexes). Senna is more widely used for hypomotility and can be given at 15mg daily in tablet form for adults.
Probiotics
Taking probiotics can help decrease gut transit time. One study showed that taking abundant probiotic species, strains, and colony-forming units can reduce transit time by 12 hours and increase stool frequency by 1.5 bowel movements per week. Working with a practitioner who understands the many varieties of probiotics on the market and which one will benefit you the most is an ideal approach to this intervention.
Prokinetics
There are both pharmaceuticals and natural substances that can provide prokinetic support. Prokinetics engages the migratory motor complexes within the gastrointestinal tract and helps propel food and metabolic waste. One well-researched combination herbal prokinetic is Iberogast, also known as STW-5. It’s a liquid extract of nine plants, including chamomile, peppermint, and licorice root. Commercially available STW-5 has a recommended dosing of 1.1 ml three times per day.
Magnesium Oxide
There are eight forms of magnesium, with magnesium oxide being the primary form taken to stimulate the GI tract. Magnesium oxide is converted to magnesium bicarbonate and magnesium carbonate. This can then help increase water in water in the stool, which increases volume, thus stimulating the intestinal wall and expulsion of stool.
Complementary and Integrative Medicine for Gastrointestinal Motility Disorders
Complementary medicine plays a vital role in holistic healthcare by offering non-pharmaceutical options to reduce symptoms and support overall digestive health.
Acupuncture
Acupuncture is a traditional and classical Chinese medicine practice that uses tiny stainless steel acu needles at specific points on the body. Utilizing points stimulating the bowels can assist in motility throughout the GI tract. Evidence shows that it can also be very beneficial as electroacupuncture, which adds gentle electrostimulation through the fine needle. Two common acupuncture points on the body that are used for motility issues are ST36 and PC6.
Massage Therapy
Abdominal massage can be an effective intervention for gastrointestinal function. If you have ever had a massage before, you can attest to how relaxing it can be for your muscles. Applying this same logic to an abdominal massage can bring context to how this can improve the nervous system and muscles that make up the GI tract. Abdominal massage can engage the parasympathetic nervous system, which, as described earlier in the article, can help tonify the enteric nervous system and, thus, the contractile function of the gut.
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Summary
A diagnosis of a gastrointestinal motility disorder can be frustrating and challenging to manage for the patient. Often, there is no one answer in addressing the dysfunction. Looking at this from an integrative medicine perspective allows you to utilize allopathic and complementary medicine interventions. This provides various tools to optimize your gastrointestinal health to the highest level possible.
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