DIGESTION and DYSMOTILITY

None of us can live without food – eating regular nutritious meals is key to our survival and health. So when something goes wrong with our digestive system, it can have far reaching consequences. A colleague told me the other day she had been diagnosed with dysmotility. I had never heard of it but it seems it is more common that most people realize.

Dysmotility affects the movement in the gut. Food travels through our digestive tracts by muscles situated in the gut wall that contract to move the food along. Abnormal contractions can occur anywhere along the length of the gut, in the oesophagus or small intestines for example. Dysmotility is when abnormal gut contractions result in slow or uncoordinated movements of these muscles which hinder the proper movement of the food. It is also sometimes known as gastropharesis or delayed gastic emptying.

To begin with, it is worth understanding how the stomach works. The stomach is a sack made of muscle and, when it's empty, it has a volume of only 50ml; this can expand to hold up to 1.5 litres or more after a meal.

The walls of the stomach are made from three different layers of muscle that allow it to churn food around and make sure it's mixed with the stomach's acidic digestive juices. The presence of hydrochloric acid in the stomach helps to kill bacteria that might be present. The stomach also produces the enzyme pepsin, which breaks down proteins.

In the gastric phase, food can stay in the stomach for up to several hours while numerous acids and enzymes are released, including the hormone gastrin. When the food has been churned into a creamy mixture known as chyme, the pyloric sphincter (an opening controlled by muscle) opens and chyme passes gradually into the small intestine.

In dysmotility, problems occur when the smooth contractions of the muscles fail; perhaps with weak or too strong contractions. If, for instance, this sphincter at the bottom of the stomach contracts too strongly, then the stomach contents won’t be able to leave the stomach at their normal sped. Or if the regular contractions and relaxation of the muscles become uncoordinated, then the food won’t be propelled forwards properly. This will also occur if the contractions are too weak or not frequent enough.

Sometimes these problems can be caused by a viral stomach upset or certain medication such as antibiotics; in other cases there is no apparent cause. It can be caused by specific foods, alcohol or even the timing of the meal – various things can affect the correct functioning of the stomach.

In dysmotility, when the food remains in the stomach longer than normal, it can lead to a number of symptoms including nausea, reflux of stomach acid, bloating and even vomiting. In some cases, it can be so severe that it can really reduce a person’s lifestyle, affecting the food they eat and the activities they undertake. Interestingly, it is more common in women than men.

Initial treatment is to try and identify the cause; perhaps eating lighter, smaller meals more often and avoiding anything that could act as a trigger. Your doctor may prescribe a prokinetic; medication that helps to promote the emptying of the stomach.
There are many other problems that can occur in the digestive system, and as always, if you have problems it is worth talking to your doctor to ensure it is identified correctly.

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