A careful history can localize gastrointestinal motility disorders and
suggest appropriate diagnostic tests. Dysphagia, odynophagia, heartbu
rn and reflux have esophageal origins. The same symptoms occur in acha
lasia, a classic motor disorder of the lower esophageal sphincter, whi
ch can be diagnosed by barium swallow, endoscopy and esophageal motili
ty studies. Nausea, vomiting, anorexia, bloating and abdominal pain ar
e symptoms of motor disorders of the stomach and small intestine. When
these symptoms are accompanied by unexplained right upper quadrant pa
in, elevated liver enzyme levels and unexplained recurrent pancreatiti
s, the diagnosis of impaired biliary motility is suggested. Colorectal
motility disorders may present as abdominal pain, diarrhea, constipat
ion and/or fecal incontinence. If symptoms do not resolve with dietary
changes and appropriate medications and the anatomy is normal on lowe
r gastrointestinal studies, colorectal motility studies may be indicat
ed.