From the Guidelines
For suspected gut dysmotility, a thorough clinical evaluation should be performed, followed by specialized tests to assess gastrointestinal motility, and treatment should be tailored to the specific type of dysmotility and underlying cause, with the primary goals of reducing symptoms, morbidity, and mortality, and improving quality of life, as recommended by the most recent guidelines 1.
Diagnostic Approach
The diagnostic approach for suspected gut dysmotility should include:
- Transit studies such as scintigraphy, wireless motility capsule, or radiopaque marker studies to measure how quickly food moves through the digestive tract
- Upper endoscopy and colonoscopy to rule out structural abnormalities
- Manometry tests (esophageal, antroduodenal, or anorectal) to measure pressure patterns and evaluate muscle function in different parts of the GI tract
Treatment Approach
The treatment approach for gut dysmotility should include:
- Dietary modifications, such as smaller, more frequent meals, avoiding trigger foods, and ensuring adequate hydration
- Medications, such as prokinetics (e.g., metoclopramide, erythromycin, or prucalopride) to enhance gastrointestinal motility
- Symptom management, including antiemetics (e.g., ondansetron) for nausea, and pain modulators (e.g., low-dose tricyclic antidepressants) for abdominal pain
- In severe cases, more invasive interventions, such as gastric electrical stimulation, botulinum toxin injections, or surgical options, may be considered, as recommended by recent guidelines 1.
Key Considerations
- The management of gut dysmotility should be individualized, taking into account the underlying cause and specific type of dysmotility, as well as the patient's overall health status and quality of life, as emphasized by recent studies 1.
- A multidisciplinary approach, involving gastroenterologists, gastrointestinal physiologists, surgeons, and other specialists, may be necessary to provide comprehensive care for patients with gut dysmotility.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Testing for Gut Dysmotility
The diagnosis and treatment of gut dysmotility involve various strategies, including:
- Identifying clinical signs of intolerance, such as nausea and vomiting, to determine the need for treatment 2
- Using prokinetic agents, such as metoclopramide and erythromycin, to promote gastric emptying and improve motility 3, 4
- Employing dietary management and gastric prokinetic agents to treat delayed gastric emptying 4
- Utilizing wireless motility capsule (WMC) testing to detect and diagnose multiregional dysmotility 5
Recommended Tests
The following tests are recommended for suspected gut dysmotility:
- Imaging studies to confirm delayed gastric emptying 4
- WMC testing to provide a comprehensive evaluation of the motility profile of the entire GI tract 5
- Gastric residual volume measurement to identify gastric dysmotility, although the threshold value for intervention is not well established 3
Treatment Options
Treatment options for gut dysmotility include:
- Prokinetic pharmacotherapies, such as metoclopramide and erythromycin, to manage upper GI dysmotility 3, 6
- Dietary management and gastric prokinetic agents to treat delayed gastric emptying 4
- Correction of electrolyte abnormalities, avoiding drugs that can decrease motility, and patient mobilization to treat lower GI dysmotility 2
- Neostigmine, endoscopic decompression, and cecostomy for colonic pseudo-obstruction 2, 3