# Dysmotility Dysmotility is a problem with normal motility (movement) of the GI tract. As food moves through the body, it is moved along with waves of contractions called peristalsis. The peristalsis movements are involuntary and are controlled by the autonomic nervous system, more specifically the vagus nerve which sends "rest and digest" signals to the body. Part of the autonomic dysfunction experienced by many people with ME/CFS is that the vagal nerve signals to the gut may be weak. This can cause trouble swallowing (esophageal dysmotility), GERD or early satiety (stomach/gastric dysmotility), or constipation (bowel dysmotility). # Constipation Most cases of constipation in ME/CFS are treatable with conservative measures as in the general population. However, in very severe cases of ME/CFS there are reports of severe gut dysmotility resulting in ileus and requiring bowel rest. I have heard of this in association with MCAS. If constipation is severe and/or accompanied with other GI symptoms, you might want to get a CTA/CTV to assess for MALS, SMAS, Nutcracker, May-Thurner, and pelvic congestion.  If one of those vascular conditions is present, there are often more than one. Options for treatment of constipation, if more conservative measures such as fiber are unsuccessful, include Lubiprostone and Linzess. # GERD GERD (gastroesophageal reflux disease), also called heartburn or acid reflux, can sometimes be a sign that the stomach is nor emptying properly. It is often associated with feeling full more quickly than normal. GERD, with or without stomach dysmotility, is commonly associated with MCAS and may improve with MCAS treatment.