Clinical, radiologic, and manometric characteristics of chronic intestinal dysmotility: the Stanford experience.
OBJECTIVE
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.
Rosa-E-Silva
Lucilene
L
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305, USA.
Gerson
Laurenb
L
Davila
Marta
M
Triadafilopoulos
George
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States