Testing for Motility Disorders: What You Need to Know

What are motility disorders?

Motility disorders affect how the muscles and nerves in the gastrointestinal tract move food from the esophagus (feeding tube) to the stomach and intestines. Motility disorders can affect any part of the gastrointestinal tract. The gastrointestinal tract includes the mouth, esophagus, stomach, intestines and colon. 

What are common symptoms of motility disorders?

Children with motility disorders can have many of the following symptoms:

• Constipation
• Diarrhea
• Abdominal (belly area) pain
• Nausea or upset stomach
• Trouble eating or swallowing
• Abdominal bloating

Which motility disorders are treated at Mass General for Children (MGfC)?

Motility symptoms and disorders treated by MGfC include:

• Dysphagia (trouble swallowing)
• Achalasia (when food cannot easily enter the stomach because the lower muscle of the esophagus becomes tight or tense, and the esophagus does not contract normally)
• Fecal incontinence (inability to control bowel movements)
• Constipation (infrequent or hard bowel movements)
• Gastroparesis (when food empties slowly from the stomach because the muscles do not work properly)
• Hirschsprung’s disease (when the nerves of the colon do not grow properly before birth, leading to issues with constipation in infancy and childhood)
• Acid reflux (when the stomach contents flow backward into the esophagus and cause a burning in the chest). Acid reflux is also called heartburn or gastroesophageal reflux disease (GERD). 

What is motility testing?

Motility testing helps doctors figure out if a person has a motility disorder. If a person has a motility disorder, motility testing also helps doctors figure out next steps. Symptoms alone cannot determine whether a person has a motility disorder.

What are the different types of motility tests?

There are many types of motility tests. Your child’s symptoms and needs can help the care team figure out which tests they might need. In most cases, children stay awake throughout motility tests. In some cases, your child might need sedation or anesthesia (medicine to help your child feel relaxed or fall asleep). Common types of motility tests include:

• Anorectal manometry. This is when a doctor places a small, flexible tube with a small balloon on the end into your child’s rectum (bottom). The catheter has sensors to detect pressure. The balloon will be inflated with different amounts of air to test how well the muscles and nerves react.
• Antroduodenal manometry. This is when a doctor places a small, flexible tube through the nose into the stomach and small intestine. The tube measures the strength of the muscles in the stomach and beginning of the small bowel to see how well they work.
• BRAVO pH test. This test measures how much acid is in the esophagus. It is used to diagnose acid reflux. A doctor will insert a flexible tube down the esophagus and attach a small pill with an acid sensor to check how much stomach acid flows up into the esophagus.
• Breath testing. This is when a doctor checks your child’s breath to measure the amount of several different gases. This can be used to diagnose lactose intolerance, fructose intolerance helicobacter pylori (bacteria that causes inflammation) and small intestinal bacterial overgrowth
• Colonic manometry. For this test, your child will be under general anesthesia for placement of a catheter (small, flexible tube) into your child’s colon. The, the catheter is connected to a computer when your child wakes up. It checks how your child’s colon (last part of the large intestine before the rectum) reacts to medications and food.
• Esophageal manometry. This is when a doctor passes a small, flexible tube from your child’s mouth down their esophagus. During the test, your child will swallow small sips of water to check how well the esophagus muscles work.
• Esophageal impedance. For this test, a doctor will pass a small, flexible tube through your child’s nose and into their esophagus and stomach. A small monitor is attached to the other end of the tube. The tube will stay in place for 24 hours. The monitor checks the amount of gas and liquid in the esophagus and signs of reflux.
• Sitzmark study. Your child will swallow 24 small rings. Five days later, they will have an x-ray to see where in the body the rings are located. This provides information on how fast the intestines are working.
• X-rays or other imaging tests. Imaging tests take pictures of different parts of the gastrointestinal tract to check for defects or blockages.