0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
Intestinal Motor Disorders 851■Occasionally intestinal bacterial overgrowth: decreased vitamin B12
levels or a positive Schilling’s test
■Plain abdominal films: air-fluid levels and/or distended loops of
small bowel
Specific Diagnostic Tests
■Upper gastrointestinal series:
➣exclusion of mechanical obstruction such as adhesions or
Crohn’s disease; dilated intestinal loops, poor motility, or diver-
ticula
■Gastric and intestinal scintigraphy:
➣assessment of the presence of a disturbed intestinal and/or
colonic transit; breath tests, such as breath hydrogen excretion,
inaccurate in intestinal pseudo-obstruction since the substrate
can be metabolized by bacterial overgrowth
■Gastroduodenal manometry:
➣measurement of the pressure profile of the stomach and small
intestine over several hours during fasting and after a standard
meal
➣manometric tracing may reveal: 1) simultaneous, prolonged con-
tractions suggestive of mechanical intestinal obstruction; 2) low
amplitude contractions suggestive of a myopathic process; and
3) abnormal organization and coordination of contractions typ-
ically associated withneuropathy
■Autonomic tests:
➣assessment of the sympathetic adrenergic, sympathetic cholin-
ergic, and vagal innervation and to differentiate a preganglionic
or central nervous system lesion from peripheral neuropathy
associated with autonomic dysfunction
■Brain and spinal cord MRI
➣important to rule out a central lesion; screening for a toxic, me-
tabolic, or paraneoplastic process should be done when periph-
eral dysautonomia is found
■Laparoscopy:
➣may be performed if mechanical obstruction suspected, or if a
venting or feeding tube needed; full-thickness intestinal biopsy
may be obtained
Other Tests
■Patients with steatorrhea, or vitamin B12 malabsorption, may ben-
efit from a quantitative small bowel aspiration culture to rule out
small bowel bacterial overgrowth