Small bowel dysmotility

Abstract

The most important initial step in treating patients with intestinal dysmotility is to exclude reversible causes, in particular mechanical obstruction. The presence or absence of bacterial overgrowth should be determined by small bowel aspirate or breath test, although an empiric trial with antibiotics is an appropriate alternative. Physicians should use agents effective against gram-negative organisms, such as broad-spectrum penicillins or tetracycline, particularly those that provide coverage of anaerobes, such as metronidazole. Nutritional support, by enteral or parenteral means, is currently the most important aspect of management of patients with severe intestinal dysmotility. A low-fat diet, supplemented by liquid formulas, can be tried first. The presence of gastroparesis should be determined; if severe, jejunal feeding should be attempted. Because of the costs and risks associated with total parenteral nutrition (TPN), every attempt should be made to use the native intestine for feeding. A trial of several days of naso-jejunal feeding can help select those patients who can obtain sufficient nutrition by enteral routes and is recommended prior to committing a patient to TPN therapy. Even while on TPN, some oral intake should be encouraged. Prokinetic agents currently in use are less effective in the small bowel than they are in the stomach. They should always be tried initially, though, particularly because improvement of concomitant gastric dysmotility can alleviate symptoms. Although certain manometric patterns can select those patients who respond better to therapy, manometry should not be used to direct therapy in individual patients. For the moment, cisapride is the drug of choice. Erythromycin, particularly when given intravenously and in small, sub-antibiotic doses, can also be tried. The role of octreotide is not clear, but when given at small doses, and when combined with erythromycin, it may be useful in selected patients. Ablative surgery may be useful in a few, highly selected patients. One of the most beneficial surgical procedures is a venting jejunostomy. The use of this simple intervention can substantially reduce the number of hospital admissions and emergency room visits in selected patients with intermittent obstructive symptoms.

Iron Deficiency in Long‐Term Parenteral Nutrition Therapy

“…Patients with dysmotility had intact bowel anatomy but often were unable to obtain sufficient nutrition by enteral feeding. However, even during PN, oral intake was still encouraged to promote use of the native intestine 23 . An earlier study on oral nutrition in HPN indicated that oral caloric intake in patients with SBS exceeded calculated resting energy expenditure and that patients with dysmotility consumed oral calories at 50% of their calculated resting energy expenditure 24 .…”

The Utility of Adding a Liquid-Nutrient Meal to Aid Interpretation of Small-Bowel Transit Scintigraphy

“…Individuals with underlying neuropathies or myopathies may also manifest symptoms of small-bowel dysmotility (1,4). These symptoms include abdominal pain, diarrhea, constipation, abdominal distension, bloating, nausea, or vomiting (2,3,5). Given these nonspecific symptoms, differentiating between upper-and lower-gastrointestinal-tract dysfunction in patients with suspected motility disorders can be challenging.…”