Original article
Clinical, Radiologic, and Manometric Characteristics of Chronic Intestinal Dysmotility: The Stanford Experience

https://doi.org/10.1016/j.cgh.2006.05.001Get rights and content

Background & Aims: The clinical spectrum of chronic intestinal dysmotility (CID) is not well known. We determined the spectrum of motor abnormalities, underlying pathology, clinical course, and response to treatment of adults with CID at a tertiary referral center. Methods: This was a descriptive retrospective analysis of a CID cohort conducted at a tertiary referral gastrointestinal (GI) motility center. A total of 113 referred patients underwent gastroduodenal manometry, other motility studies as appropriate, and radiologic and/or endoscopic assessment to exclude mechanical intestinal obstruction. Results: Common symptoms included abdominal distention, abdominal pain, nausea, and constipation. The course was chronic with intermittent symptoms. Gastroduodenal manometry was abnormal in all patients; a pattern suggestive of a neuropathic process was the most common. Other GI motility studies showed delayed gastric, gallbladder, and colonic transit, nonspecific esophageal dysmotility, sphincter of Oddi hypertonicity, and poor rectal balloon sensation/expulsion. Treatment involved nutritional support, prokinetics, analgesics, antinausea agents, and laxatives, with variable response and high morbidity, multiple emergency admissions, need for nutritional support, and poor response to surgery. Nearly 40% of the patients underwent abdominal surgery. Conclusions: Patients with CID have a chronic course and high morbidity. Because any segment of the GI tract may be involved in CID, functional assessment of the entire GI tract is recommended. CID presents several unmet clinical needs even in tertiary centers with expertise.

Section snippets

Patients

We reviewed the medical records of 113 patients with the diagnosis of CID. All patients had recurrent symptoms suggestive of bowel obstruction in the absence of a mechanical occlusion. The manometric criteria for the diagnosis of CID as originally proposed by the Mayo Clinic11 (see below) were fulfilled by all 113 patients (19 male, 94 female; median age, 43 years [range, 18–80 years]). These patients were evaluated and managed at the Stanford Hospital GI Motility Center between 1999 and 2004.

Clinical Presentation

The median age of symptom onset was 37 years (range, 8–77 years). Figure 1 shows the distribution of GI symptoms at presentation. The median scores for each symptom were 3 for abdominal distention, abdominal pain, and bloating; 2 for nausea and constipation; 1 for vomiting, diarrhea, and heartburn; and 0 for dysphagia. Systemic or non-GI symptoms included weight loss (in 64%), fatigue (in 12%), arthralgia (in 11%), orthostatic hypotension (in 10%), weakness (in 10%), myalgia (in 10%), urinary

Discussion

Our cohort study suggests that adults with CID have multiple GI symptoms, including abdominal distention, pain, nausea, and others, as well as non-GI symptoms, including urologic, rheumatologic, and neurologic symptoms. Because any segment of the GI tract or the entire GI tract may be involved in adult CID, a functional assessment of the entire GI tract is recommended.

In our study, the diagnosis of CID was made on the basis of suggestive symptoms, exclusion of mechanical obstruction by

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    Dr Rosa-e-Silva was supported by a grant from the Capes-Coordenaçaô de Aperfeiçoamento de Pessoal de Nível Superior and from the Universidade Estadual de Londrina-Brazil to serve as a visiting scholar at the Division of Gastroenterology and Hepatology, Stanford University. Dr Triadafilopoulos is a Consultant to almost all the major pharmaceutical companies that are active in the area of gastroesophageal reflux. He has received funding for studies, seminars, and travel from such companies and has an equity position in Curon Medical, Inc. His research is supported by the National Institutes of Health (DK063624).

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