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Precision-guided diagnosis for digestive rhythm and nerve-control disorders.

Overview

The Motility & Neurogastroenterology unit specialises in disorders where the nerves and muscles of the digestive tract fail to coordinate normally. These conditions cause difficulty swallowing, reflux, bloating, and chronic constipation that persist even when endoscopy results appear normal.

Using high-resolution manometry, pH-impedance monitoring, gastric-emptying studies, and transit testing, our specialists evaluate the movement and nerve signals of the oesophagus, stomach, intestines, and pelvic floor. Treatment focuses on restoring natural digestive motility through medication, diet planning, and targeted biofeedback therapy.

Conditions We Treat

  • Achalasia & Esophageal Spasm
  • Gastroparesis (Delayed Gastric Emptying)
  • Chronic Idiopathic Constipation / Colonic Inertia
  • Pelvic Floor Dyssynergia & Functional Outlet Obstruction
  • Functional Dyspepsia
  • Aerophagia & Reflux Hypersensitivity
  • Functional Chest Pain
  • Chronic Bloating & Small-Bowel Dysmotility



Achalasia

Overview

Achalasia is a rare esophageal motility disorder in which the lower esophageal sphincter (LES) fails to relax and the muscular contractions of the esophagus become uncoordinated. As a result, food and liquid have difficulty passing into the stomach, leading to progressive swallowing problems and regurgitation.

The condition occurs when the nerve cells responsible for esophageal movement degenerate, disrupting normal swallowing reflexes. It can appear at any age but is most often diagnosed in middle-aged adults.

Symptoms

  • Difficulty swallowing: Both solids and liquids (progressive dysphagia)
  • Regurgitation: Of undigested food or saliva, especially at night
  • Chest pain: Or pressure after meals
  • Heartburn-like discomfort: That doesn’t improve with antacids
  • Frequent throat clearing: Coughing, or aspiration at night
  • Unexplained weight loss

Diagnosis

  • High-Resolution Manometry: The gold-standard test that measures pressure changes along the esophagus and identifies failed relaxation of the LES.
  • Barium Swallow (Esophagram): Reveals classic “bird’s beak” narrowing at the lower esophagus.
  • Upper GI Endoscopy: Excludes obstruction, malignancy, or stricture that can mimic achalasia.
  • CT or MRI (if indicated): Evaluates for secondary causes like tumor-related pseudoachalasia.

Treatment

  • Endoscopic Botox Injection: Botulinum toxin injected into the LES provides temporary relaxation for patients unfit for surgery.
  • Laparoscopic Heller’s Myotomy: Surgical cutting of the LES muscle fibres to provide long-term relief from obstruction.
  • Peroral Endoscopic Myotomy (POEM): A minimally invasive endoscopic approach offering similar outcomes with faster recovery.
  • Lifestyle & Dietary Adjustments: Eating smaller, softer meals, staying upright after eating, and avoiding late-night meals.



Gastroparesis (Delayed Gastric Emptying)

Overview

Gastroparesis is a chronic condition in which the stomach muscles do not contract properly, causing delayed emptying of food into the small intestine. This occurs when the vagus nerve or stomach muscle coordination is disrupted, slowing digestion without any physical blockage.

It can be triggered by diabetes, viral infections, certain medications, or post-surgical nerve injury, and often leads to nausea, early satiety, and bloating. Early diagnosis and targeted treatment help prevent nutritional deficiencies and improve quality of life.

Symptoms

  • Feeling full after eating small amounts: (early satiety)
  • Nausea and vomiting: Of undigested food hours after meals
  • Bloating: And abdominal discomfort
  • Loss of appetite: And unintentional weight loss
  • Fluctuating blood sugar levels: (especially in diabetics)
  • Acid reflux or heartburn

Diagnosis

  • Gastric Emptying Scintigraphy: A radioactive test that measures how quickly food leaves the stomach.
  • Gastric Manometry: Evaluates electrical and muscular activity of the stomach.
  • Upper Endoscopy: Rules out ulcers or structural obstructions.
  • Blood Tests: Assess thyroid function, glucose control, and electrolytes.

Treatment

  • Dietary Management: Small, low-fat, low-fibre meals; preference for liquid or pureed foods to aid gastric passage.
  • Medications: Prokinetics (e.g., metoclopramide, erythromycin) to stimulate stomach contractions. Antiemetics to control nausea and vomiting.
  • Glycaemic Control: Tight blood sugar management for diabetic gastroparesis.
  • Endoscopic / Surgical Interventions: Botox injection at the pylorus to ease stomach outlet resistance. Gastric Electrical Stimulation (GES) for refractory cases.
  • Nutritional Support: Oral supplements or jejunal feeding for severe or malnourished patients.



Chronic Constipation (Colonic Inertia)

Overview

Chronic constipation is a long-standing condition where bowel movements become infrequent, incomplete, or difficult to pass. In colonic inertia, the muscles of the large intestine move stool too slowly, while in outlet obstruction or pelvic floor dysfunction, the anal muscles fail to coordinate properly.

The condition can be related to lifestyle, medication, or underlying motility disorders. Persistent constipation not only causes discomfort and bloating but can lead to fissures, haemorrhoids, and reduced quality of life if untreated.

Symptoms

  • Fewer than three bowel movements per week
  • Hard, dry, or lumpy stools
  • Excessive straining: During defecation
  • Sensation of incomplete evacuation
  • Abdominal bloating or discomfort
  • Dependence on laxatives: For relief

Diagnosis

  • Detailed History & Physical Exam: To rule out medication, diet, or endocrine causes.
  • Colonic Transit Study: Tracks marker movement through the colon to measure speed.
  • Anorectal Manometry: Assesses sphincter muscle strength and coordination.
  • Balloon Expulsion Test: Evaluates pelvic floor relaxation and outlet function.
  • Defecography or MRI Pelvic Floor Imaging: Visualises rectal and anal movement during evacuation.

Treatment

  • Lifestyle & Dietary Changes: High-fibre diet (25-30 g/day) and adequate hydration. Regular exercise and consistent bowel routine.
  • Medications: Osmotic or stimulant laxatives for mild cases. New-generation agents such as lubiprostone, linaclotide, or prucalopride to improve motility.
  • Biofeedback Therapy: Targeted pelvic floor retraining to correct muscle coordination and improve evacuation.
  • Interventional Options: Transanal irrigation or sacral nerve stimulation in refractory cases. Surgical colectomy considered rarely for proven colonic inertia unresponsive to other treatments.



Pelvic Floor Dysfunction

Overview

Pelvic floor dysfunction refers to the inability to correctly relax and coordinate the muscles of the pelvic floor during bowel movements. This leads to difficulty passing stool, straining, incomplete evacuation, and chronic constipation, even when stool consistency is normal.

The condition can result from nerve injury, childbirth, aging, pelvic surgery, or chronic straining. Because symptoms overlap with other motility disorders, accurate diagnosis through specialised testing is crucial for lasting relief.

Symptoms

  • Chronic constipation: With prolonged straining
  • Incomplete evacuation: Or need for digital pressure to pass stool
  • Pelvic heaviness or pain: After defecation
  • Leakage of stool: (faecal incontinence) or mucus
  • Urinary urgency: Or difficulty voiding in some cases

Diagnosis

  • Anorectal Manometry: Measures anal sphincter pressures and coordination during straining.
  • Balloon Expulsion Test: Evaluates ability to expel a simulated stool-like balloon.
  • Defecography / MRI Pelvic Floor Imaging: Provides visual assessment of muscle movement and rectal emptying.
  • Surface EMG (Electromyography): Detects abnormal muscle or nerve activity.

Treatment

  • Pelvic Floor Biofeedback Therapy: The most effective non-surgical treatment. Sensors and visual feedback help retrain muscles to relax and coordinate properly.
  • Medications: Stool softeners or mild laxatives to ease passage while retraining muscles.
  • Physiotherapy & Muscle Training: Specialised exercises focusing on muscle awareness, relaxation, and strength restoration.
  • Lifestyle Measures: Avoid excessive straining, maintain hydration, and follow regular bowel habits.
  • Surgical Options: Rarely indicated; reserved for structural issues like rectoceles or prolapse.



Functional Dyspepsia

Overview

Functional Dyspepsia is a chronic upper digestive disorder characterised by recurring discomfort or pain in the upper abdomen without any identifiable structural or biochemical cause. It is often related to abnormal gut sensitivity, delayed stomach emptying, or stress-related nerve dysfunction.

Unlike gastritis or ulcers, the stomach lining appears normal on endoscopy, yet patients experience persistent symptoms that can mimic acid reflux or indigestion. The condition requires a balanced approach involving dietary changes, medication, and gut-brain modulation.

Symptoms

  • Persistent fullness or heaviness: After meals (postprandial distress)
  • Early satiety: Feeling full after small amounts of food
  • Upper abdominal pain: Burning, or bloating
  • Nausea: And occasional vomiting
  • Loss of appetite: And weight fluctuations
  • Burping: Or excessive gas

Diagnosis

  • Upper GI Endoscopy: To rule out ulcers, reflux disease, or structural abnormalities.
  • Gastric Emptying Study: Identifies delayed stomach motility.
  • H. pylori Testing: Detects infection that can worsen symptoms.
  • Abdominal Ultrasound / CT: Excludes gallbladder or pancreatic conditions.
  • Symptom Assessment: Diagnosis is clinical when all structural causes are excluded.

Treatment

  • Dietary & Lifestyle Modifications: Smaller, frequent meals; avoid spicy, fatty, or acidic foods. Limit caffeine and alcohol; stop smoking.
  • Medications: Prokinetics (e.g., domperidone, metoclopramide) to enhance gastric emptying. Acid suppressants (PPIs or H2 blockers) to reduce irritation. Neuromodulators (low-dose antidepressants) to reduce visceral hypersensitivity.
  • Stress Management: Relaxation therapy, yoga, or psychological counselling for gut-brain balance.
  • Nutritional Support: Balanced, easily digestible diet with adequate hydration.



Bloating & Small Bowel Dysmotility

Overview

Bloating and small bowel dysmotility occur when abnormal intestinal movement or nerve dysfunction causes trapped gas, abdominal distension, and discomfort. Unlike temporary bloating due to diet, this condition is chronic and often linked to intestinal muscle weakness, nerve injury, diabetes, post-infectious changes, or small intestinal bacterial overgrowth (SIBO).

Patients frequently experience fullness, excessive burping, or visible abdominal swelling after meals. Early diagnosis helps identify underlying motility or microbial causes, preventing malnutrition and chronic pain.

Symptoms

  • Persistent bloating: And abdominal fullness
  • Visible distension: That worsens through the day
  • Excessive gas: Burping, or flatulence
  • Abdominal discomfort: Or cramping
  • Early satiety: And nausea
  • Fatigue: Or light-headedness after eating

Diagnosis

  • Breath Tests: Detect bacterial overgrowth (SIBO) or carbohydrate malabsorption (lactose, fructose).
  • Gastric Emptying & Transit Studies: Evaluate how fast food moves through the stomach and intestines.
  • Abdominal Imaging (Ultrasound/CT): Rules out mechanical obstruction or tumour.
  • Laboratory Tests: Assess for thyroid disorders, celiac disease, or diabetes.

Treatment

  • Dietary Therapy: Low-FODMAP diet to reduce fermentable carbohydrates. Avoid carbonated drinks, artificial sweeteners, and high-fat meals.
  • Medical Management: Prokinetic agents (e.g., prucalopride, erythromycin) to stimulate intestinal contractions. Antibiotics (e.g., rifaximin) to treat bacterial overgrowth. Antispasmodics for relief from intestinal cramping.
  • Gut Microbiota Support: Use of probiotics and fibre balance to restore microbial health.
  • Lifestyle Modifications: Regular physical activity and stress reduction to improve gut motility.
  • Interventional Options: In severe dysmotility, nutritional support or decompression procedures may be considered.
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