Functional And Gi Motility Disorders

The clinical problems and dilemmas which the busy clinician encounters on a daily basis are the main focus of this publication. Emphasizing a clinical rather than a pathophysiological approach to problems, it facilitates access and helps the practicing clinician to develop an effective and efficient diagnostic and therapeutic strategy. Nevertheless, clinically important aspects of pathophysiology are also dealt with in detail when called for. A variety of scenarios that are especially relevant to modern medical practice, such as the intensive care unit, are taken into account. A group of internationally renowned experts guides the reader through the broad variety of diagnostic options available to assist in the assessment of symptoms originating anywhere along the gastrointestinal tract, from the esophagus to the anus, and, in each instance, every effort is made to critically appraise the technology discussed. Moreover, general overviews of broadly relevant therapeutic approaches are also provided.

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.

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.

Handbook of Gastrointestinal Motility and Functional Disorders is a user-friendly handbook that reviews the latest and most up-to-date information on the evaluation of symptoms and diagnostic tests of GI motility and functional GI disorders and a practical approach on how to treat these disorders. Each chapter is written by an international expert in the field who was carefully chosen for his or her renowned scientific and clinical expertise. The book brings together the essence of science and art in the practice of neurogastroenterology and GI motility. The chapters are enriched with algorithms, tables, and figures to enhance learning and readability. Each chapter follows a specific outline; chapters on symptoms follow the format of definition, pathophysiology, and evaluation of the symptoms, whereas the chapters on specific disorders follow the format of definition, diagnosis, and treatment. This allows for quick reading of the various chapters and to gain up-to-date knowledge of the topic. Each chapter also includes extensive color pictures and illustrations of each test involved and descriptions of how to perform and interpret the motility tests that are incorporated into patient care decisions. Handbook of Gastrointestinal Motility and Functional Disorders by Drs. Satish S. C. Rao, Henry P. Parkman, and Richard W. McCallum will be useful for practicing physicians, junior academicians, GI fellows, young faculty, motility laboratory personnel, surgeons, internists, physician assistants, family practitioners, and nurse practitioners who all encounter the common problems of dysphagia, heartburn, nausea, vomiting, abdominal pain, irritable bowel syndrome, constipation, and fecal incontinence in their daily practice. The update on management and therapy completes the Handbook of Gastrointestinal Motility and Functional Disorders and explains how to integrate this diagnostic information into decision making, and how to translate this to day-to-day patient care.

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. ​

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.

​This book describes the causes and clinical management of functional gastrointestinal disorders in a readily understandable way, with the aid of many clear illustrations. The concrete and practical advice provided will be most helpful in the clinical practice of both the general practitioner and the medical specialist. Functional disorders of the gastrointestinal tract, such as gastroesophageal reflux disease, functional dyspepsia, and irritable bowel syndrome, are very common and chronic conditions. Despite the recent publication of many scientific papers on their diagnosis and treatment, much remains unclear, and management is still considered challenging. This practice-oriented book will be an ideal source of reliable up-to-date guidance for all who care for these patients.

Clinical and Basic Neurogastroenterology and Motility is a state-of-the-art, lucidly written, generously illustrated, landmark publication that comprehensively addresses the underlying mechanisms and management of common adult and pediatric motility disorders. These problems affect 50% of the population and include conditions such as dysphagia, achalasia, gastroesophageal reflux disease, gastroparesis, irritable bowel syndrome (IBS), gas and bloating, SIBO, constipation and fecal incontinence. The book brings together international experts and clinician scientists, epitomizing their years of wisdom into a concise yet practical text that is delivered in two distinct sections, basic and clinical. It fulfills a large unmet need, and bridges a long-awaited knowledge gap among trainees, clinicians, scientists, nurses and technicians, earnestly engaged in this field. First of its kind text that covers both basic and clinical aspects, bridging the knowledge gap, and providing a bench to bedside approach for management of common disorders Discusses the latest concepts and basic principles of neurogastroenterology and motility, and how the gut and brain interact in the genesis of functional gastrointestinal and motility disorders Provides an illustrated and practical text on hot topics written by leading adult and pediatric gastroenterology experts across the globe Includes an accompanying more detailed web version of the text with free access to future podcasts