Small bowel motility disorders.

Small bowel motility disorders may result in prolonged or accelerated transit and present clinically with such symptoms as nausea, vomiting, bloating, pain or altered bowel movements. These disorders result from derangements of neuromuscular control affecting extrinsic nerves, enteric plexuses or smooth muscle, or from structural disorders that may be congenital or acquired. Diagnosis depends on exclusion of mechanical obstruction or structural disease and assessment of motor function by measurement of transit and intestinal pressure profiles, and a search for the underlying disorder causing a neuropathy or myopathy. Management of stasis syndromes is based on restoration of good nutrition, treatment of bacterial overgrowth, prokinetic agents, antiemetics and surgery for localized disease. Patients with fast transit disorders require opioid agonists and, rarely, second-line treatments such as verapamil, clonidine or octreotide.