Motility Disorders: From Esophagus to Colon
Published August 2019
When Digestion Stops
You do it all day, but take it for granted.
“You never think about your ability to swallow and eliminate food until the process doesn’t work,” says Northwestern Medicine Esophageal Gastroenterologist John E. Pandolfino, MD. “Then, it can be scary and painful.”
What’s the key to keeping digestion moving from esophagus to colon? Motility, or the contraction of the muscles that mix and move what’s inside your gastrointestinal tract. Digestion is a balance of contraction and relaxation. When something inhibits either, motility disorders occur.
“Motility disorders are really plumbing issues in many instances,” adds Dr. Pandolfino. “Often, we can’t fix what’s causing the problem, but we can prevent it from obstructing swallowing and digestion with various leading-edge treatments.”
Here is a closer look at four common motility disorders.
“Constipation, which occurs in the colon, is one of the most important motility disorders,” says Dr. Pandolfino. It affects four million Americans on a chronic basis. It’s defined broadly as having a bowel movement less than three times per week, but it can also be related to not feeling completely empty or having to strain to have a bowel movement. The complications of constipation can include:
- Hemorrhoids, or swollen veins in the rectum.
- Anal fissures, or tearing of the rectum.
- Diverticular disease.
- Rectal prolapse, when a piece of your intestinal lining pushes out of your anus due to strain.
- Fecal impaction, when stool gets stuck, causing a backup.
Constipation is primarily caused by lifestyle and sometimes related to issues with the pelvic floor muscles. Learn about treatment options here.
Achalasia is caused by nerve damage in the esophagus, specifically at the muscular valve that connects the bottom of the esophagus to the top of the stomach. The nerves don’t allow this area to relax, which prevents food from entering the stomach. This can lead to another motility symptom, dysphagia, or difficulty swallowing. It can also result in a variety of health complications, including chest pain, weight loss, malnutrition, aspiration pneumonia, esophageal cancer and perforation of the esophagus from the food buildup.
The cause of achalasia in unknown, but it is associated with many factors, including:
- Family history
- Abnormal immune system
- Possible viral infection
- Age (most frequently occurs in people ages 30 to 60)
“There are many treatment options for achalasia,” says Dr. Pandolfino. “A common treatment offered at Northwestern Medicine is the per oral endoscopic myotomy (POEM), where physicians use a scope inserted into the mouth to cut the muscles at the bottom of the esophagus to allow food to move into the stomach.”
Learn more about achalasia treatment here.
Gastroesophageal Reflux Disease (GERD)
You’ve likely experienced heartburn after a big, greasy meal. GERD is a more severe version of this, where the valve at the base of the esophagus either opens spontaneously or doesn’t close properly, allowing the acidic stomach juices to enter the esophagus. If left untreated, GERD can cause inflammation or narrowing of the esophagus, dysphagia, Barrett's esophagus, and rarely esophageal cancer.
Risk factors for developing GERD include:
Certain foods, including those that are highly acidic or spicy, can exacerbate GERD symptoms.
“We’ve seen patients get their esophageal motility disorders under control with diet therapies,” says Dr. Pandolfino. “This approach has been effective for everything from heartburn to the more complex motility disorders.”
Learn more about GERD treatments here.
Gastroparesis occurs when your stomach takes too long to empty, resulting in a buildup of undigested food. As you can imagine, this can result in great discomfort and lead to nausea, vomiting, GERD, loss of appetite and weight loss. Gastroparesis is most commonly associated with type one diabetes and can make it difficult for people with diabetes to manage their blood sugar levels. Gastroparesis has been linked to damage in the vagus nerve, which controls lower gastrointestinal motility, from the stomach to the colon.
New treatments for gastroparesis are developing focused around using the POEM technique to open up the pylorus muscle, which separates your stomach from your small intestine. This muscle is the gatekeeper for food to enter your small intestine. Additionally, there are new medications that are being developed to kickstart the motility of the stomach, showing promise for improving symptoms for patients with gastroparesis.
Learn more about gastroparesis treatment options here.
Better Care for Motility Disorders
“Motility disorders are very complicated and we are still trying to understand why they occur,” says Dr. Pandolfino. “Northwestern Medicine is one of the top centers in the country for the diagnosis and treatment of motility disorders, and we are continuing to do leading-edge research looking for cures.”