Abell T L, Werkman R F
University of Tennessee, Memphis, College of Medicine, Memphis, Tennessee, USA.
Am Fam Physician. 1996 Feb 15;53(3):895-902.
A careful history can localize gastrointestinal motility disorders and suggest appropriate diagnostic tests. Dysphagia, odynophagia, heartburn and reflux have esophageal origins. The same symptoms occur in achalasia, a classic motor disorder of the lower esophageal sphincter, which can be diagnosed by barium swallow, endoscopy and esophageal motility studies. Nausea, vomiting, anorexia, bloating and abdominal pain are symptoms of motor disorders of the stomach and small intestine. When these symptoms are accompanied by unexplained right upper quadrant pain, elevated liver enzyme levels and unexplained recurrent pancreatitis, the diagnosis of impaired biliary motility is suggested. Colorectal motility disorders may present as abdominal pain, diarrhea, constipation and/or fecal incontinence. If symptoms do not resolve with dietary changes and appropriate medications and the anatomy is normal on lower gastrointestinal studies, colorectal motility studies may be indicated.
详细的病史可以定位胃肠道动力障碍，并提示合适的诊断性检查。吞咽困难、吞咽痛、烧心和反流都源于食管。贲门失弛缓症也会出现同样的症状，它是一种典型的食管下括约肌运动障碍，可通过吞钡造影、内镜检查和食管动力研究来诊断。恶心、呕吐、厌食、腹胀和腹痛是胃和小肠运动障碍的症状。当这些症状伴有无法解释的右上腹疼痛、肝酶水平升高和无法解释的复发性胰腺炎时，则提示存在胆道动力受损。结直肠动力障碍可能表现为腹痛、腹泻、便秘和/或大便失禁。如果症状在饮食调整和使用适当药物后仍未缓解，且下消化道检查显示解剖结构正常，则可能需要进行结直肠动力研究。
