MOTILITY INVESTIGATIONS Presented by: A/Prof GWEE Kok Ann In the absence of structural disease, many gastrointestinal symptoms may be related to disturbances in the motor functions of various parts of the gastrointestinal tract, otherwise known as motility disorders. Table 1 shows some types of motility tests that are available, and describes the motility disorders for which these tests may be helpful and symptoms that may suggest a motility disorder. Tests Disorders Symptoms which the patient may have Oesophageal manometry, 24-hour pH monitoring, acid sensitivity testing • gastrooesophageal reflux disease • swallowing disorders, eg achalasia • heartburn • acid regurgitation • difficulty in swallowing (dysphagia) • pain on swallowing (odynophagia) • non-cardiac chest pain Gastric emptying studies: a) 99technetium labelled scintigraphy b) 13C-labelled gastric emptying (non-radioactive) • post-gastrectomy, post- vagotomy • diabetic gastroparesis • post-viral gastroparesis • anorexia nervosa • scleroderma • amyloidosis • delayed gastric emptying eg nausea, vomiting, belching, bloating, fullness, early satiety • dumping syndrome: abdominal cramps, diarrhoea, cold sweat, palpitations, fainting occuring 15-30 mins after a meal Intestinal transit: • orocaecal (small intestinal) transit time • colonic transit time • colonic inertia • bacterial overgrowth • chronic idiopathic intestinal pseudoobstruction (CIIP) • Parkinson's disease, scleroderma, amyloidosis, myopathy • chronic diarrhoea • colonic constipation Anorectal manometry • pelvic floor dysfunction, anismus • pudendal neuropathy • Hirschsprung's disease • megarectum • chronic constipation • incontinence