Intestinal Motility Disorders Differential Diagnoses

  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Feb 23, 2012
 
 

Diagnostic Considerations

Failure to make the correct diagnosis of an intestinal motility disorder is a medicolegal pitfall, especially in patients with irritable bowel syndrome (IBS), because several cancers of the digestive tract mimic this condition, even in late stages.

The criteria for diagnosis of intestinal pseudo-obstruction should include definite symptoms and signs of obstruction, with documentation of an ileus or air-fluid levels on plain radiographs of the abdomen or a dilated duodenum, small intestine, or colon on barium radiographs. Even though severe dysmotility may otherwise be present, the term pseudo-obstruction should not be used when these radiographic findings are absent.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Alcohol-related neuropathies
  • Electrolytic imbalance
  • Poisoning due to environmental agents
  • Maldigestion

Counseling with a neuropsychologist, evaluation by an endocrinologist, and research into toxins and drugs in the blood may be helpful for diagnosis.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Nafisa K Kuwajerwala, MD  Staff Surgeon, Breast Care Center, William Beaumont Hospital

Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Disease, and American Society of Breast Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Venkata Subramanian Kanthimathinathan, MD  Fellow in Bariatric/Advanced Laparoscopic Surgery, University of Missouri Healthcare

Disclosure: Nothing to disclose.

Luigi Santacroce, MD  Assistant Professor, Medical School, State University at Bari, Italy

Disclosure: Nothing to disclose.

Vivek V Gumaste, MD  Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Silvia Gagliardi, MD Consulting Staff, Department of Surgery, Medical Center Vita, Italy

Disclosure: Nothing to disclose.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Shivkumar Prabhu, MD Consulting Staff, Department of Internal Medicine, St John Detroit Riverview Hospital

Disclosure: Nothing to disclose.

Daniel Schafer Department of Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Di Lorenzo C, Youssef NN. Diagnosis and management of intestinal motility disorders. Semin Pediatr Surg. Feb 2010;19(1):50-8. [Medline].

  2. Keller J, Layer P. Intestinal and anorectal motility and functional disorders. Best Pract Res Clin Gastroenterol. 2009;23(3):407-23. [Medline].

  3. Venkatasubramani N, Sood MR. Motility disorders of the gastrointestinal tract. Indian J Pediatr. Oct 2006;73(10):927-30. [Medline].

  4. Ouyang A, Locke GR 3rd. Overview of neurogastroenterology-gastrointestinal motility and functional GI disorders: classification, prevalence, and epidemiology. Gastroenterol Clin North Am. Sep 2007;36(3):485-98, vii. [Medline].

  5. Rao SS. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastroenterol Clin North Am. Sep 2007;36(3):687-711, x. [Medline].

  6. De Giorgio R, Cogliandro RF, Barbara G, Corinaldesi R, Stanghellini V. Chronic intestinal pseudo-obstruction: clinical features, diagnosis, and therapy. Gastroenterol Clin North Am. Dec 2011;40(4):787-807. [Medline].

  7. Rudolph CD, Hyman PE, Altschuler SM, Christensen J, Colletti RB, Cucchiara S, et al. Diagnosis and treatment of chronic intestinal pseudo-obstruction in children: report of consensus workshop. J Pediatr Gastroenterol Nutr. Jan 1997;24(1):102-12. [Medline].

  8. Knowles CH, Martin JE. Slow transit constipation: a model of human gut dysmotility. Review of possible aetiologies. Neurogastroenterol Motil. Apr 2000;12(2):181-96. [Medline].

  9. Amiot A, Tchikviladze M, Joly F, et al. Frequency of mitochondrial defects in patients with chronic intestinal pseudo-obstruction. Gastroenterology. Jul 2009;137(1):101-9. [Medline].

  10. Li B, Wang JR, Ma YL. Bowel sounds and monitoring gastrointestinal motility in critically ill patients. Clin Nurse Spec. Jan 2012;26(1):29-34. [Medline].

  11. Remes-Troche JM, Rao SS. Diagnostic testing in patients with chronic constipation. Curr Gastroenterol Rep. Oct 2006;8(5):416-24. [Medline].

  12. Maqbool S, Parkman HP, Friedenberg FK. Wireless capsule motility: comparison of the SmartPill GI monitoring system with scintigraphy for measuring whole gut transit. Dig Dis Sci. Oct 2009;54(10):2167-74. [Medline].

  13. Burns AJ. Disorders of interstitial cells of Cajal. J Pediatr Gastroenterol Nutr. Dec 2007;45 Suppl 2:S103-6. [Medline].

  14. He CL, Burgart L, Wang L, Pemberton J, Young-Fadok T, Szurszewski J, et al. Decreased interstitial cell of cajal volume in patients with slow-transit constipation. Gastroenterology. Jan 2000;118(1):14-21. [Medline].

  15. Pardi DS, Miller SM, Miller DL, Burgart LJ, Szurszewski JH, Lennon VA, et al. Paraneoplastic dysmotility: loss of interstitial cells of Cajal. Am J Gastroenterol. Jul 2002;97(7):1828-33. [Medline].

  16. Sanders KM. Interstitial cells of Cajal at the clinical and scientific interface. J Physiol. Nov 1 2006;576(Pt 3):683-7. [Medline].

  17. Cleveland Clinical Foundation, Center for Gastrointestinal Motility Disorders. Intestinal motility disorders. Available at: http://www.ccf.org/gastro/motility/default.htm. Cleveland, Ohio: Cleveland Clinic;. 1999. [Full Text].

  18. Fu A. Neostigmine: an alternative treatment for constipation. Dynamics. 2005;16(1):13-5. [Medline].

  19. Karamanolis G, Tack J. Promotility medications--now and in the future. Dig Dis. 2006;24(3-4):297-307. [Medline].

  20. Sarna SK. Molecular, functional, and pharmacological targets for the development of gut promotility drugs. Am J Physiol Gastrointest Liver Physiol. Oct 2006;291(4):G545-55. [Medline].

  21. Quigley EM. Prucalopride: safety, efficacy and potential applications. Therap Adv Gastroenterol. Jan 2012;5(1):23-30. [Medline]. [Full Text].

  22. Mazzone A, Farrugia G. Evolving concepts in the cellular control of gastrointestinal motility: neurogastroenterology and enteric sciences. Gastroenterol Clin North Am. Sep 2007;36(3):499-513, vii. [Medline].

  23. Sigurdsson L, Reyes J, Kocoshis SA, et al. Intestinal transplantation in children with chronic intestinal pseudo- obstruction. Gut. Oct 1999;45(4):570-4. [Medline].

  24. Millar AJ, Gupte G, Sharif K. Intestinal transplantation for motility disorders. Semin Pediatr Surg. Nov 2009;18(4):258-62. [Medline].

 
Previous
Next
 
Dilated cecum (16 cm) and colon in patient with pseudocolonic obstruction.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.