Neurological disorders and small bowel dysmotility

Abstract

Purpose of reviewSmall bowel dysmotility is common in the context of neurological disorders. Overlooking it can have an adverse impact on patient's quality of life and neurological outcomes. This review focuses on describing the mechanisms and effects of enteric dysmotility in neurological patients and providing treatment options.Recent findingsSmall bowel dysmotility is prevalent among neurological patients. The definition and diagnosis of small bowel dysmotility is a challenge; however, up to two-thirds of neurological patients may experience associated symptoms. Small bowel dysmotility can affect the absorption of nutrients and medication, impacts on social and professional function and can result in malnutrition and its associated morbidity and mortality.SummarySmall bowel dysmotility due to a neuropathy can result from acute or chronic disorders in the central and peripheral nervous system and includes the cerebral cortex, brain stem, spinal cord, parasympathetic (vagus) and sympathetic nerves and the myenteric and submucosal plexuses of the intestine. Generalized muscle disorders can also cause an enteral myopathy. Generally, the disorders may be degenerative or inflammatory. Both enteric neuropathy and myopathy may cause symptoms of abdominal pain, nausea/vomiting, bloating, constipation or diarrhoea and can cause malnutrition. The symptoms need to be addressed in order of importance to the patient and malnutrition prevented or treated.

Troubleshooting the pediatric gastrostomy

“…Often, this is encountered in patients with cerebral palsy or patients with similar neurologic impairments (eg, traumatic brain injury); central nervous system problems often manifest as (among other problems) enteric nervous system dysfunctions. 30 Prolapse often prompts surgical revision or even resiting, but these interventions will fail if the dysmotility is not addressed. Medical management of dysmotility is beyond the scope here, but sometimes the solution is medical (eg, low-dose erythromycin or other prokinetics 31 ) or mechanical (GJ-tube, pyloroplasty, etc).…”

“…Mucosal prolapse virtually always signifies at least a gastric outlet restriction. Often, this is encountered in patients with cerebral palsy or patients with similar neurologic impairments (eg, traumatic brain injury); central nervous system problems often manifest as (among other problems) enteric nervous system dysfunctions 30 . Prolapse often prompts surgical revision or even resiting, but these interventions will fail if the dysmotility is not addressed.…”