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Gut Motility disorders
Background
Gut Motility disorders: Gastro-oesophageal Reflux; Intractable Vomiting; Intestinal Pseudo-Obstruction; Severe Constipation
The contents of the gut are moved from mouth to anus in a carefully regulated fashion in order that food may be digested and absorbed and the exhausted waste expelled. The power for movement originates from the muscle coats of the bowel, which are controlled by an intrinsic network of nerves within the gut wall called the enteric nervous system (ENS). In addition, the function of the ENS and muscles cells is also controlled by the brain via the sympathetic and parasympathetic nerves (extrinsic to the gut), by hormones from endocrine cells and by the immune system. Congenital abnormality or acquired disease may affect any of these components in any part of the bowel to produce dysfunction that results in a gut motility disorder. As a result, such disorders comprise a large group that may vary in their clinical features.
The disorders may be restricted to only part of the gut such as gastro-oesophageal reflux or may diffusely affect the gut and even the urinary bladder as in hollow visceral myopathy. Gastro-oesophageal reflux with a hiatus hernia occurs in 1 in 500 live births and intestinal pseudo-obstruction and very severe constipation in 1 in 4,500. The latter are due to a heterogeneous group of disorders in which developmental abnormality of the enteric nerves and muscle coats occurs. The commonest of these is Hirschsprung's disease.
