Small bowel motility: ready for prime time?

The primary function of the small bowel is the absorption of nutrients, and the motor patterns of the healthy bowel are intended to promote that function. The motor patterns of the small bowel are the result of close interaction between the enteric nervous system, extrinsic nerves, regulatory peptides, and the intestinal smooth muscle. The basic electrical rhythm governing intestinal contractions is determined by specialized pacemaker cells called the interstitial cells of Cajal. Diseases affecting any of these components may result in intestinal dysmotility and its associated symptoms. Although transit studies and intestinal manometry are helpful in the diagnosis of dysmotility, our understanding of pathophysiology is hampered by the difficulties involved in obtaining and analyzing intestinal tissue. Treatment of intestinal dysmotility relies on dietary manipulations and nutritional support (enteral or parenteral) because there is no drug therapy that can effectively enhance the propulsive function of the small bowel. Small bowel transplantation remains a life-saving intervention for patients who fail to respond to other therapies.