Intestinal Motor Disorders

The phrase “intestinal dysmotility” refers to a broad range of clinical conditions characterized by impaired peristalsis. In children, common symptoms of intestinal dysmotility include constipation, encopresis, diarrhea, vomiting, and abdominal pain. Less frequently, severe chronic constipation, failure-to-thrive, abdominal distension, enterocolitis, or other obstructive symptoms are present. The majority of patients with a history of dysmotility suffer from functional disorders that have no established organic etiology and are diagnosed using symptom-based criteria (Stordal et al., Acta Pediatr 90:638–642, 2001; Loening-Baucke, Constipation and encopresis. In: Wyllie R, Hyams JS and Kay M (eds) Pediatric gastrointestinal and liver disease. Saunders Elsevier, Philadelphia, 2006). However, for pediatric patients, particularly those with severe symptoms, anatomic pathology is often sought and occasionally found to explain their clinical problems. In some, the cause is an acute or intermittent obstructive condition (e.g., atresia, volvulus, intussusception, etc.) associated with obvious gross pathology, subjects that are covered in Chap. 1 . Conditions dominated by diarrhea, which are principally inflammatory or infectious, are also discussed elsewhere in this text (see Chaps. 4 and 6 ). The pathological correlates of the remaining infants and children, who exhibit severe chronic constipation or “pseudo-obstruction,” are the focus of this chapter.