Finding a Diagnosis: Functional Changes

Jul 21, 2017 by


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Let’s take a look at what happens when the GI tract doesn’t move the way that it should.  Whether it involves food moving in the wrong direction or going nowhere at all, the symptoms are impossible to ignore.  And when they are left uncontrolled, there can be some unwanted consequences. So, it’s important to recognize them when they do exist.

Gastroesophageal Reflux Disease (GERD) and Indigestion

GERD is a common condition that occurs more often with age and pregnancy.  It can also be there alongside many other GI conditions, which causes it to get confused with those other GI conditions.

What is GERD?

Because it is so common, it’s important to really understand what the term “GERD” actually means.  The definition is:

The flow of stomach acid or stomach contents back into the esophagus

In this case, the stomach contents/acid are moving passively into the esophagus and throat.  There’s no forceful movement, like you might experience with vomiting.  That can make it hard to realize that the pain is due to acid – there’s no feeling or movement that comes with it.  But this simple backward flow of the stomach acid can lead to burning, chest pain, cough, hoarseness, and sore throat.  The pain can be so bad at times that many people head to the Emergency Room thinking that they are having a heart attack!

The presence of GERD typically means that the esophageal sphincter isn’t working quite as well as it should.  You may be eating a type of food that is causing it to loosen up (caffeine and chocolate are two of the biggest culprits) or taking a medication that is making this happen (hormones, nicotine, pain medications, and anxiety medications are pretty popular medications that can do this).

GERD vs. Indigestion

Indigestion is the direct result of eating a specific item that is disagreeable to your stomach. GERD, on the other hand, is a condition that is always there, but can become even worse when certain foods are eaten.  Not surprisingly , GERD is often confused with indigestion.

As you might imagine, knowing which problem you have would change the way that you treat it.  If you have GERD, you might need to take a medication every day to keep your acid reflux under control.  By doing this and avoiding the foods and medications that can loosen your sphincter, you can often keep it under control.  But if you have indigestion, then you might need to only watch what you eat, and be prepared for certain symptoms when you eat foods that you shouldn’t.

 IBS (Irritable Bowel Syndrome)

IBS is a relatively common con­dition, with somewhere between 5-20% of people across the world having some form of it.  The symptoms for this condition run a strange gamut for each individual person and may have a dominant symptom of diarrhea, constipation, or, for some people, a mixture of both.

IBS is a condition that is currently only diagnos­able by the symptoms experienced. There is no official test that allows a doctor to definitively identify the presence of IBS. The tool used for this diagnosis is called the Rome III Criteria and requires someone to have at least two of the following:

  1. Symptoms are relieved by going to the bathroom
  2. Recognized changes were associated with a dif­ference in stool frequency
  3. Recognized changes were associated with a dif­ference in stool appearance

Other indicators that IBS may be present can include excessive straining or urgency when stool­ing, many and frequent trips to the bathroom, and a feeling of bloating. There is no doubt that some of these symptoms show up for every person at times. However, those with IBS experience these specific symptoms very consistently, to the point that they can lead to a notable reduction in quality of life.

If these changes sound familiar to you, most of your question on IBS can be answered in this section.

Reduced Motion in the GI Tract (Motility Disorders)

The so-called “motility disorders” are a group of conditions that all have the same common issue – the GI tract isn’t moving the way that it should.  In order to understand how this happens, it is important to understand peristalsis, the movement of the GI tract muscles.  Click here if you need to read up on peristalsis.

The symptoms a motility disorder causes all depends on where it happens in the GI tract.  And that’s why there are so many type to begin with.  But don’t be fooled – while these disorders may happen separately, they can also happen together.


This occurs when the esophagus stops moving properly and the sphincter that connects the esophagus to the stomach becomes stiff.  One of the common symptoms with this condition makes a lot of sense – difficulty swallowing.  There are a number of other, very uncomfortable things that can happen with achalasia, including choking, heartburn, hiccups, chest pain, and regurgitating food.

While it is not possible to make your esophagus work again, there are some procedures and surgeries that can make it easier to swallow food.  Many people with achalasia find that they need to alter their diets and habits in order to make it easier for their bodies to process the foods that they eat.


Gastroparesis occurs when the stomach stops moving properly and empties very slowly into the intestine. The change in motility can be very different from person to person, which means that the symptoms of gastroparesis are also very different from person to person.

As you might expect when the stomach isn’t working, people with gastroparesis feel full, a lot.  They lose the ability to digest food adequately, which means it can be hard to stay nourished.  When the stomach doesn’t empty, the food also hangs around for a long time.  That can cause all kinds of additional symptoms, such as nausea, vomiting, acid reflux, bloating, pain, food regurgitation, and more.  And when the stomach empties slowly and doesn’t digest well, the problems move right on down to the intestine, causing constipation, diarrhea, cramping, gas, and sugar imbalances.

It’s very important to recognize that with a condition like gastroparesis, no one person will experience every single possible symptom.  This can make it difficult to identify.  It is also not entirely uncommon for someone with gastroparesis to have some of the symptoms of achalasia, meaning that both the esophagus and stomach have been impacted by the motility change.

There is plenty of information on gastroparesis here if you are interested in learning more.

Intestinal Pseudo-Obstruction

As you might have guessed, we’re moving our way down the GI tract!

When motility changes occur in the intestine, they lead to a condition known as intestinal pseudo-obstruction.  This should not be confused with true intestinal obstruction, which occurs much more often.  If you have any of the symptoms that we are about to discuss, let your doctor know so that you can be checked for a true obstruction (which may be a medical emergency).

Reduced motility in the intestine can be incredibly uncomfortable and difficult to manage.  The most common symptoms are significant swelling of the intestine and abdomen, and the pressure pain that can come with that.  It may also cause constipation and/or diarrhea, and as the food backs up in the GI tract, it can lead to nausea and vomiting.  Poor nutrition and poor quality of life are the biggest concerns with this condition.

It is possible for someone with a gastroparesis diagnosis to also have an intestinal pseudo-obstruction diagnosis, indicating that motility has been altered all the way down the GI tract.  In fact, much of the information about managing gastroparesis can be helpful to understanding and managing intestinal pseudo-obstruction, and you can find that here.

Don’t see something that fits your symptoms?  Have no fear.  Next up, we’re going to look at the inflammatory changes that can cause the GI tract to go a little bit haywire.

Or you can skip ahead to the step-by-step guideline on how to figure out what is causing your GI symptoms.



Next: Inflammatory Issues

Or refer back to the Unclear (or No) Diagnosis Section

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