Evaluation Of Gastrointestinal Motility And Its Disorders

This volume features chapters written by experts from global academia, including from India, Singapore, Japan, Taiwan, Europe and USA, integrating knowledge on evaluation methods with evidence of best practices for the management of motility disorders.

This multi-authored book covers most aspects of evaluation of gastrointestinal motility – a field that has been expanding in recent times largely due to advances in diagnostic modalities; coupled with this, new evidences supporting best practices have increased the interest among clinical gastroenterologists, researchers, teachers and trainees in gastrointestinal motility and its disorders. New advances in the field of evaluation of functional bowel diseases and motility disorders, such as high-resolution manometry, 24-h pH impedance monitoring, Bravo capsule pH-metry, barostat, balloon expulsion test, barium and MR defecography, biofeedback, hydrogen breath tests, motility capsule (smartpill) etc. have significantly expanded the scope and outcome of treating these disorders. The chapters have been contributed by a well-conversant group of experts from the global academia, including India, Singapore, Thailand, Korea and Australia, integrating the body of knowledge on evaluation methods with evidence of best practices for the management of motility disorders. A chapter on how to set-up a manometry laboratory provides key information for clinicians and researchers who are planning to start working in this area. With 11 chapters in the book supported with numerous tables, flow charts, schematic diagrams and images, professionals will find it an essential reading. ​

Gastrointestinal motility has evolved from an esoteric laboratory tool into a sophisti cated diagnostic technique that is now widely used clinically to guide in management of complex gastrointestinal problems. Today, it is the most rapidly growing subspecialty within gastroenterology. Previously, many of the gastrointestinal motility problems were either ignored or attributed to a disturbance of "psyche." But with the growing knowledge and understanding of how a dysfunction of the gastrointestinal muscle and nerves can cause disease, we are at the threshold of a revolution in our approach to the diagnosis and treatment of gastrointestinal motility disorders. The purpose of this book is to serve as a useful, up-to-date reference manual and guide for the diagnostic and therapeutic approach towards common adult and pediatric gastrointestinal motility problems. In order to enhance the understanding of these disor ders, a problem-oriented approach has been chosen, and wherever possible the authors have provided clinical case scenarios to illustrate their message. The emphasis has been on how to diagnose and treat motility disorders rather than to provide an encyclopedic infor mation. The reference list at the end of each chapter should enable the enthusiast to seek further information. Some of the material presented in this book has been derived from the proceedings of the annual University ofIowa College of Medicine GI Motility Symposia.

This issue of Gastroenterology Clinics of North America is on Gastrointestinal Motility Disorders. GI motility disorders are common reasons for patients to see gastroenterologists. Knowledge of the pathophysiology, evaluation and treatment of these disorders is important to appropriately care for patients with gastrointestinal motility disorders in clinical practice. The chapters of this issue will discuss key aspects of gastrointestinal motility disorders focusing on how they relate to practicing gastroenterologists and other health care providers. Current knowledge in the area as well as evolving concepts from clinical investigations and translational research from basic sciences will be discussed. The rapid explosion of new technology used in the evaluation of patients will be covered.

Together with Consulting Editor, Dr. Alan Buchman, Dr. Parkman has created as state-of-the-art issue devoted to the modern technology and approaches for evaluation and treatment of GI motility. He has provided coverage for the esophagus, colon, small intestine, and gut. Leaders in the field have contributed the detailed clinical review articles on the following topics: Enhancing High Resolution Esophageal Manometry: Use of Impedance, multiple rapid swallows, Position change, Solid food boluses, and other techniques; EndoFLIP in the esophagus: Assessing sphincter function, wall stiffness, motility to guide treatments; Evaluation and Treatment of patients with persistent reflux symptoms despite PPI treatment; Esophageal Evaluation for Patients undergoing Lung Transplant Evaluation: What should we do for evaluation and management; Tailoring Endoscopic and Surgical Treatments for GERD; Endoscopic and Surgical Treatments for Achalasia: Who to treat and how; Enhancing Scintigraphy for evaluation of gastric, small bowel, colonic motility; Targeting treatment for gastroparesis: Use of clinical tests to guide treatments; Endoscopic and Surgical Treatments for Gastroparesis: What to do and Whom to treat; Gastric Biopsies in Gastroparesis: Insights to Gastric Neuromuscular Disorders to Help with treatment; SIBO: How to diagnose and treat (and then treat again); Assessing anorectal function in constipation and fecal incontinence; Treating chronic abdominal pain in patients with Chronic Recurrent Abdominal Pain and IBS; and Refractory Chronic Constipation: How to evaluate and treat. Gastroenterologists will come away with the technical information they need to improve outcomes in their patients.

This guide focuses on the answers to patient questions that are frequently posed to providers who care for patients with GI motility disorders. Additionally, the text guides clinicians through the complicated diagnostic and therapeutic/management approaches to motility disorders, including common and specialized tests, drug initiation, medications side effects, and disease complications. Written by experts in the field, Gastrointestinal Motility Disorders: A Point of Care Clinical Guide is a valuable reference for busy clinicians who need the best evidence-based answers to patient questions at their fingertips.

Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

Has a systematic approach to the workup, diagnosis and treatment of gastrointestinal motility disorders. The book covers techniques used to evaluate motility, identifies diseases that cause abnormal motility and explains the relationship between these diseases and syndromes encountered in practice.