The “Ascending Cascade” of Colorectal Motility Disorders: A Narrative Review of Hindgut‑Driven Global Gut Dysfunction and Foregut–Airway Sequelae

Abstract

Objectives: To synthesise emerging evidence that colorectal motility disorders, traditionally viewed as isolated hindgut conditions, may initiate a progressive, system‑wide sequence of gastrointestinal and extra‑intestinal dysfunction. This review proposes an “ascending cascade” model in which partial functional obstruction of the hindgut triggers upstream effects on the midgut, foregut, biliary‑pancreatic axis, and respiratory and ENT systems.

Design: Narrative review.

Data Sources: PubMed, Embase, Scopus, and Google Scholar were searched for literature relating to colorectal motility disorders, partial obstruction, dysbiosis, small bowel bacterial overgrowth, duodenal compression syndromes, biliary disease, reflux, and gut–airway interactions. Additional anatomical and physiological sources were reviewed to support mechanistic interpretation.

Eligibility Criteria: Studies, case series, anatomical analyses, and mechanistic reports describing hindgut obstruction, colonic stasis, vascular watershed vulnerability, ileocecal reflux, midgut dysfunction, duodenal compression, biliary sequelae, and foregut or respiratory manifestations were included. Both paediatric and adult populations were considered.

Results: Evidence suggests that hindgut partial functional obstruction generates intraluminal hypertension, segmental distention, and low‑grade ischemia at antimesenteric and marginal arcade watershed zones. These changes promote mucosal barrier disruption, bacterial translocation, dysbiosis, appendiceal stasis, ileocecal reflux, backwash ileitis, Peyer’s patch activation, and mesenteric adenitis. Proximal propagation of pressure and stasis contributes to small bowel bacterial overgrowth and ileal dysfunction. Mesocolonic traction at the duodenojejunal flexure may produce functional variants of midgut malrotation or non‑rotation, while high DJ insertion can mimic superior mesenteric artery syndrome, leading to duodenitis, pancreatitis, cholecystitis, cholelithiasis, and biliary gastritis. These midgut and biliary disturbances subsequently impair gastric emptying and oesophageal barrier function, resulting in gastro‑oesophageal reflux, reflux oesophagitis, and laryngopharyngeal reflux. Chronic refluxate exposure is associated with recurrent respiratory infections, tonsillitis, sinusitis, otitis media, and periodontal disease.

Conclusions: Colorectal motility disorders may represent the initiating event in a broader, ascending continuum of gastrointestinal and extra‑intestinal pathology. Recognising this cascade may improve diagnostic accuracy, reduce fragmented care, and support earlier, more holistic intervention. Further research is needed to validate anatomical and mechanistic pathways and to determine whether targeted treatment of hindgut dysfunction can prevent upstream complications.

Keywords: Colorectal Motility Disorders; Hindgut Obstruction; Intraluminal Hypertension; Watershed Ischemia; Dysbiosis; Ileocecal Reflux; Small Bowel Bacterial Overgrowth (SIBO); Duodenojejunal Flexure; Mesocolonic Traction; Midgut Malrotation Variants; Superior Mesenteric Artery (SMA) Syndrome; Duodenitis; Pancreatitis; Biliary Stasis; Gastro‑Oesophageal Reflux Disease (GERD); Laryngopharyngeal Reflux; Respiratory and ENT Infections; Global Gut Dysfunction; Ascending Cascade Model

Citation

Zaparackaite I, Govani ND, Singh H, Singh SJ, Mehta AR, Midha PK, et al. The “Ascending Cascade” of Colorectal Motility Disorders: A Narrative Review of Hindgut-Driven Global Gut Dysfunction and Foregut–Airway Sequelae. WebLog J Gastroenterol. wjg.2026.a2804. https://doi.org/10.5281/zenodo.18463481