The clinical presentation of mitochondrial disease can involve a number of organ systems which are seemingly unrelated. Gastrointestinal manifestations are often an early presentation of mitochondrial disorders. Dysphagia, feeding difficulties, gastroesophageal reflux, dysmotility with delayed gastric emptying, intestinal pseudo-obstruction, diarrhea and pancreatic exocrine insufficiency are amongst the major complications. Neuromuscular dysfunction affecting peristalsis is a common pathophysiologic mechanism causing many of these symptoms and treatment is primarily supportive.