Small intestine and colon motility

Motor abnormalities of the small and large intestine are commonly observed in functional and organic gastrointestinal disorders. However, the presence of some of these patterns of ‘dysmotility’ in healthy controls, the absence of correlation with symptoms, and the poor response to treatments has raised questions as to whether these are epiphenomena rather than pathophysiologically relevant. This is especially the case in functional disorders such as irritable bowel syndrome and slow transit constipation, where the direction of thinking has moved towards consideration of sensitivity and autonomic nerve factors. In organic motility disorders, such as chronic intestinal pseudo-obstruction and post-operative ileus, the presence of predictable abnormalities of small bowel motility has helped define the condition, although radiological proof of dilated small bowel remains the gold standard. To date, the response of symptoms to treatments targeting motility for these conditions has remained disappointing. Recognition of the interplay between motility and sensory function in functional and organic gastrointestinal disorders has pointed towards the potential for novel putative pharmacological and physical therapies, respectively the corticotrophin-releasing factor antagonists and electrical neuromodulation of spinal and gut reflexes.