dysmotilité

Dysmotilité, or dysmotility, refers to abnormal motor activity of the digestive tract, leading to delayed or accelerated transit or uncoordinated peristalsis. It can affect any segment from the esophagus to the colon and may be primary or secondary to another disease or medication.

Clinical manifestations vary by site. Esophageal dysmotility may cause dysphagia or chest pain; gastroparesis includes nausea, early satiety, bloating and vomiting; small-bowel dysmotility causes pain, bloating, nausea with possible malabsorption; colonic dysmotility presents with constipation or diarrhea and abdominal discomfort. In severe cases, a pseudo-obstruction may occur.

Etiology includes diabetes with autonomic neuropathy, systemic sclerosis and other connective tissue diseases, neurodegenerative or myopathic disorders, postoperative changes, infections, and drugs such as opioids, anticholinergics, and calcium-channel blockers. In many patients the cause remains idiopathic.

Diagnosis relies on history and targeted testing to characterize the site and severity of impaired transit, and to exclude obstruction. Tests may include esophageal manometry, gastric emptying studies, and small- or large-bowel transit studies, as well as anorectal manometry with defecography. Endoscopy and laboratory tests are used to identify alternative diseases.

Management emphasizes treating underlying conditions when possible, dietary adjustments (smaller, more frequent meals, tailored fiber intake), and symptom-directed therapies. Prokinetic drugs such as metoclopramide, domperidone, erythromycin or prucalopride may help. In gastroparesis, options include gastric electrical stimulation or pyloroplasty in refractory cases. Dyssynergic defecation may respond to biofeedback; bowel regimens and, in severe cases, parenteral nutrition.

Prognosis depends on the affected segment and underlying disease; some patients improve with medical therapy while others require ongoing multidisciplinary care.