Motility Lab and Advanced Motility Services

What Are the Various Motility Disorders in Gastroenterology?

Motility disorders are characterized by abnormal movements of the GI tract that cause symptoms like pain, bloating, and either constipation or diarrhea. Some other common symptoms include dysphagia. Some common GI motility disorders include:

• Gastroesophageal Reflux Disease (GERD): This is described as a condition where the lower esophageal sphincter fails to function in such a manner that the gastric acids get to reflux back to the esophagus. Due to this failure, acid leaks out from the stomach and upwardly flows to cause irritation in the esophagus lining. This brings out the symptoms of heartburn, regurgitation, or even chest discomfort. When GERD results in continuous exposure, it can cause inflammation in the esophageal lining and ultimately lead to more serious complications, including esophagitis and Barrett's esophagus.
• Irritable Bowel Syndrome (IBS): IBS is a functional GI disorder with a group of symptoms that manifest as abdominal pain, bloating, and alterations in bowel habit—constipation, diarrhea, or an interaction of both. Motility disorders in the intestines are often linked as a contributing cause to IBS illnesses, in which the muscles contract either too vigorously or too weakly. Stress and dietary factors make the effects of IBS really hard to control.
• Gastroparesis: Gastroparesis is a case of delayed emptying of the stomach due to weak muscles in the stomach, or impaired functioning of the nerves. This gives a description of the slow movement of food from the stomach to the small intestine and exhibits symptoms like nausea, vomiting, early satiety, and bloating. Causes of gastroparesis include a damaged vagus nerve due to the complications of diabetes or, in most cases, idiopathic causes.
• Achalasia: Achalasia is a disorder of the motility of the esophagus in which the lower esophageal sphincter does not relax appropriately, hindering the normal passage of food from the esophagus down to the stomach. This dysfunction results in dysphagia, post-stellar regurgitation of undigested food and chest pain. The condition is generally due to loss of nerve cells in the esophagus that usually orchestrate muscle contractions and sphincter relaxation.
• Functional Constipation: Functional Constipation can be defined as a disturbance in bowel movements arising from abnormal patterns of colonic motility. Infrequent defecation is the common complaint from those having functional constipation. Unlike other forms of constipation that may be due to structural problems, functional constipation is generally related to disturbances in the coordinated contractions of the colon.
• Intestinal Pseudo-obstruction: Intestinal pseudo-obstruction is a relatively uncommon condition where the intestines act as if there was a blockage of the bowel with pain, bloating, and vomiting, but there actually is no physical blockage. It results from impaired motility of the intestinal muscles due to genetic conditions, autoimmune diseases, or damage to nerves that control bowel movements. The symptoms can be quite bad and may at times need interventions to relieve pain and improve bowel movements.

What Are the Various Motility Lab and Advanced Motility Services Provided at Marengo Asia Hospitals?

Marengo Asia Hospitals offers various advanced motility services and tests for the GI motility assessment:

1. Esophageal Manometry: It is a test that is performed to measure the function of the esophagus by evaluating the pressure and peristalsis coordination of its muscle contractions. To do so, a small, flexible tube is passed through the nose and into the esophagus, where it can measure pressures during the act of swallowing. This test then comes in handy in detecting the kind of condition associated with, for example, abnormal esophagus relaxation such as achalasia and gastroesophageal reflux disease, of which ineffective muscular activities are among the contributors to acid reflux. The test gives elaborate information on the motility patterns of the esophagus and hence helps in guiding appropriate treatment strategies.
2. Rectal Manometry: Rectal Manometry assesses the function of the rectal and anal sphincters, which gives a supportive diagnosis for disorders in defecation. The test is performed by inserting a catheter in the rectum, then measuring the pressure and muscle contractions in the anal canal and rectum. It aids in the evaluation of conditions, including but not limited to functional constipation, in which abnormal rectal motility affects bowel movement, and fecal incontinence, in which control over bowel movement is lost. This detailed analysis informs further in the de-escalation of some strategic therapies against the respective issues.
3. 24-hour pH Monitoring (24 pH Metry): It measures esophageal acid exposure for a whole day to document the severity of esophageal reflux and GERD. In this test, a thin probe is positioned inside the esophagus through the nose to record the number and time of acidic exposures. This continuous monitoring achieves a view of reflux patterns and helps in diagnosing and managing GERD. It is considerably valuable in evaluating the efficacy of existing treatment and the identification of patterns of refluxing not otherwise captured by other, shorter test methods.
4. Colonic Transit Study: The test is used to evaluate the colon's ability to process and move the waste material into and through the gastrointestinal tract. The patient swallows a capsule with markers that are later located in X-rays taken over a series of days. By examining the passage of these markers, the test specifies the speed and efficiency of colonic transit. It is useful in diagnosing constipation and other conditions of dysmotility in the colon, since it gives an insight into the functioning and movement of the colon.
5. Gut Microbiome Test: Gut microbiome test refers to the analysis of the composition and levels of gut microbiota—the community of live microorganisms present in the digestive tracts. This test examines stool specimens to pick out imbalances or changes in the gut flora that would affect both digestion and overall health. Knowledge of the microbiome can help in the diagnosis of gastrointestinal disturbances related to conditions and can guide the interventions of restoring balanced gut flora.
6. Breath Test: Breath testing includes several tests, such as the Hydrogen Breath Test for a variety of diagnoses, including lactose intolerance, fructose intolerance, and small intestinal bacterial overgrowth. You are given a sugar solution, and then gasses like hydrogen and methane are tested for in the breath. Bacterial overgrowth in the small intestine is diagnosed from high levels of these gasses in the breath, which is an important qualitative and quantitative information to manage dietary and therapeutic interventions.
7. Fecal Microbiota Transplantation (FMT): The transplantation of fecal microbiota—more commonly referred to as fecal microbiota transplantation—involves the transfer of stool from a healthy donor to a patient for the purpose of restoring a balanced gut microbiota. It is mainly used in patients with recurrent Clostridium difficile infections resistant to standard therapy. Reimplantation of a healthy microbiome in FMT leads to re-establishment of normal gut functioning and consequently shifts to improved symptoms, with this new approach giving a significant therapeutic option in the management of chronic infections and in dysbiosis.
8. Gastric Emptying Studies: Gastric Emptying Studies are specialized tests used to assess the rate related to the efficiency and timing of the stomach in emptying its contents into the small intestine. These studies are important in diagnosing several gastrointestinal conditions reflecting abnormal stomach motility, like gastroparesis, whereby the stomach empties at a rate slower than normal, resulting in symptoms like nausea, bloating, and discomfort. Such studies are generally comprised of two primary components:
   1. Gastric Emptying Time: This test measures the time taken by food to leave the stomach and enter the small intestine. By tracking the rate at which food moves through the stomach, healthcare providers can identify abnormal patterns, like delayed gastric emptying. This, therefore, provides crucial information for the diagnosis of conditions such as gastroparesis and for instituting appropriate treatment.
   2. Electrogastrography (EGG): This is a non-invasive test for recording the stomach muscles' electrical activity. These electrical signals coordinate the contractions that move the food through the digestive system. EGG analyzes stomach electrical rhythms, aiding in the diagnosis of motility disorders and providing information about other underlying problems that affect gastric emptying.

What Are the Advantages of Gastrointestinal Motility Procedures?

The benefits of GI motility procedures include:

• Accurate Diagnosis: These tests derive precise information about the digestive system. They assist in the identification of specific motility problems. For instance, esophageal manometry can reveal the exact nature of the contractions in the esophagus, differentiating the disorder in the esophagus as achalasia or spasm.
• Personalized Treatment: High-resolution data available from motility studies allow healthcare providers to design treatment strategies that are tailor-made to the condition of the particular patient. For example, if the results of gastric emptying studies suggest delayed emptying of the stomach, the strategies of treatment could be modified specifically to correct the given disorder, including modifying one's diet or the possibility of prescribing medications to enhance gastric motility.
• Improved Management: Several symptoms can be managed properly with these motility techniques, which enable the identification of the efficacy of treatment and the making of necessary adjustments. For instance, a 24-hour pH monitoring test, if conducted after introducing a new medication to control acidity, tests how well the acidity is being controlled by that specific medication. In such continuous evaluation lies the key to optimize the therapies towards the best possible outcome for the patient.
• Minimally Invasive: Most of the studies in GI motility are designed to be minimally invasive and, thereby, reduce the need for more aggressive surgical interventions. The techniques often include the placement of tiny, flexible tubes, or ingestion of contrast materials, making the recovery quick and less painful when compared to invasive procedures.
• Comprehensive Insight: These tests have a comprehensive look at the functioning of other body parts in the GI tract, hence offering comprehensive insight into disorders of motility. For example, scintigraphy tests follow the way food is passed through the digestion process and hence clearly illustrate how well the various parts of the GI can digest and move food. Such a comprehensive view is helpful in diagnosing complex motility conditions and in planning comprehensive treatment strategies.