EP.407/ Motility Tests To Ask For If You Have Night Time (Or Anytime!) Abdominal Spasms
A week or two back I did an episode on the small intestine spasm seen in 100% of endo participants in a study on endometriosis and SIBO.(1)
Last week I shared about this observation on Instagram and the post went wild. It had 100,000 views, hundreds of comments, thousands of saves and so many of you wrote to me to say that you get a spasm like pain in your intestines over night.
I am going to do some more digging, as I’ve never come across more research looking into this issue since that study, which was in 1998. I could have certainly missed it, so I’ll look again, but in the meantime, it’s clear something is going on and many of you are suffering.
Now, I am going to do another episode on other intestinal spasms that could also be happening in the night, because I think some of us are having different experiences, but today I want to do a short episode on the main motility tests we can get for the small intestines that I advise my clients to discuss with their GI doctor.
So the first is an Antroduodenal Manometry test.(2) This is going to test your migrating motor complex. So just to remind you, the migrating motor complex is a wave like motion that occurs in your small intestine two hours after eating and overnight, and it turns off whenever you eat.(3) It’s purpose is to clean your small intestine of food debris and bacteria, which don’t belong in the small intestine - remember, most of you bacteria should be in the large intestine, and when it builds up in the small intestine, that is when we get SIBO.(4)
It’s not the nicest test, essentially, a tube is inserted through the nose and down the stomach and first part of the small intestine, this is normally performed under sedation.
After this is inserted, it’s left remaining for several hours, and you will be given a meal. The tube inserted will monitor your migrating motor complex throughout this time, to see how it responds after food and when you are resting.
It’s considered an invasive test and my understanding is it can take quite some convincing to get a doctor to do the test.
However, there is an alternative and that’s the SmartPill test.(5)
This involves swallowing an electronic capsule that has wireless sensors - you won’t digest it, it will pass through your entire digestive tract, and as it does, it will record the motility speeds of your stomach, small intestine and large intestine.
This option is particularly useful for those of us who may have stomach motility issues such as Dumping Syndrome or gastroparesis, which can be very common in those of us with endo and hEDS and I have an episode on these issues that I’ve linked to in the show notes.(6)
Now, theses test are checking whether there is something functionally wrong with the MMC, for example, if it’s being slowed down by anti-viculin antibodies from food poisoning, or a condition like hypothyroidism, and in our case, is there a spasm of the enteric nervous system also happening at the same time as the MMC (but the MMC in unaffected, at least based on the study I shared in my previous episode on this topic).
But there is another test, which can show us whether there is a structural issues blocking the MMC from doing its job properly, for example, when there are adhesions or a small bowel obstruction causing the small intestine to kink or twist.
The first test is called a Barium Swallow or a Barium SI Series.(7) This is where you drink a chalky white solution made of barium sulphate, which coats the intestinal tract and then x-ray video is used to record the motility of the upper GI tract, including swallowing, stomach emptying and the MMC.
The barium swallow test can help highlight structural abnormalities, such as distortion in the small intestines like strictures from adhesions, that could be affecting motility function.
Now, I actually requested one of these myself, but was informed that due to the radioactive risks of X-rays, that a contrast MRI or CT was preferable and would generally show up any issues caused by adhesions or any blockages.(8) However, from my research, it appears that the barium swallow is still better suited for investigations that require examining how swallowing, muscles and motility are working in real time.
Now, please remember I am not a GI doctor and that this is just general guidance, but from what I can find, these are the main tests for investigating motility disorders. At least this gives you some information to take to your doctor and discuss, and hopefully, this will help you begin getting answers to what’s behind your nighttime intestinal spasms.
Okay, I’ll see you next week!
References
1) https://pubmed.ncbi.nlm.nih.gov/9660426/
2) https://stanfordhealthcare.org/medical-treatments/e/endoscopy/types/small-bowel-manometry.html
3) https://www.sciencedirect.com/topics/medicine-and-dentistry/migrating-motor-complex
4) Diagnosis and management of small intestinal bacterial overgrowth - PubMed, Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth - PubMed, The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine - PubMed, The migrating motor complex: control mechanisms and its role in health and disease - PubMed,Gastrointestinal motility disorders and bacterial overgrowth - PubMed, Modern concepts of small intestinal bacterial overgrowth - PMC
5) https://pubmed.ncbi.nlm.nih.gov/24881810/
6) https://www.theendobellycoach.com/podcast/delayed-gastric-emptying-endo-sibo-gastroparesis
7) https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/barium-swallow
8) https://www.whittington.nhs.uk/default.asp?c=42427
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