Clinical and Basic Neurogastroenterology and Motility

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 Cover Clinical and Basic Neurogastroenterology and Motility Copyright Dedication Contributors About the editors Foreword Preface Acknowledgments Section A: Foundations of neurogastroenterology and motility 1 Nerves, smooth muscle cells and interstitial cells in the GI tract: Molecular and cellular interactions Introduction Motility of the GI Tract Myogenic regulation—If movement occurs there must be a motor Structural features of smooth muscle cells Excitation–contraction (E–C) coupling in GI smooth muscle cells Electro-mechanical coupling in SMCs and ionic conductances Pharmaco-mechanical coupling in SMCs SIP syncytium—Input from middle management Structure and function of ICC Pacemaker ICC and mechanism of electrical slow wave Neural regulation via ICC Mechanosensitive responses of ICC Structure and function of PDGFR α + cells SIP syncytium as the basis for myogenic regulation of motility Defects in the SIP syncytium leading to motility dysfunction Neurogenic regulation—Contributions from the executive suite Structural organization of the ENS Development of the ENS Reflex activation of ENS Connectivity of the ENS with the central nervous system Conclusions Acknowledgments References Further reading 2 Gut and brain interactions Introduction Gut to brain interactions A mind of its own: The intrinsic innervation of the gut—The enteric nervous system Extrinsic nerves relay sensory information to the brain The role of immune cells in gut-brain communication The microbiota-gut-brain axis Mechanisms of neuronal sensitization Brain to gut interactions Spinal-DRG circuitry Brainstem circuitry Cortico-limbic circuitry: Pain and stress Modulating the immune system in the CNS affects descending pathways to the gut Conclusions and clinical implications Acknowledgments References 3 Neuroimaging and biomarkers in functional gastrointestinal disorders: What the scientists and clinicians need to know about ... Introduction The starting point Common neuroimaging techniques and approaches for assessing brain mechanisms in IBS Functional imaging studies Task-based or evoked-functional magnetic resonance imaging (fMRI) Resting-state fMRI (rsMRI) Macro- and micro structural imaging studies Structural (s)MRI Diffusion MRI Molecular studies Radioligand PET studies Pharmacological (pH) fMRI Interventional phenotyping with fRMI MR spectroscopy studies Imaging genetics Two decades of brain imaging studies in IBS: What have we discovered? Functional imaging findings Structural imaging findings White matter findings Sex-specific brain alterations in IBS Comparison with other chronic pain disorders Brain imaging, genetics and signaling systems underlying symptoms and pathophysiology in IBS Corticotropin-releasing factor signaling Noradrenergic signaling pathways Neurokinin-1 receptor signaling Serotonin signaling system Brain-gut-microbiome axis Current limitations Moving forward and the path ahead Conclusions References 4 Gut microbiota and immunology of the gastrointestinal tract The gut microbiome Gastrointestinal immunity The epithelial barrier Innate immunity Adaptive immunity Tolerance to commensal microorganisms The gut microbiome and immune development The gut microbiome and immune maintenance Species competition Maintaining the epithelial barrier Modulating adaptive immune responses Dysbiosis of the gut microbiome Inflammatory bowel disease Celiac disease Type I diabetes Diseases affecting other organs Colorectal cancer Conclusions References Further reading 5 Esophageal anatomy and physiology Esophageal anatomy Esophageal barrier function Esophageal motor functions Lower esophageal sphincter closure Lower esophageal sphincter relaxation Conclusions References Further reading 6 Gastroduodenal anatomy and physiology Introduction Embryology of the stomach and duodenum Innervation of the stomach and duodenum Vagal and sympathetic nerves Enteric nervous system Vascular supply of stomach and duodenum Normal gastric fundus and body function Microscopic anatomy of the proximal stomach Neurophysiology of the gastric reservoir Normal antrum and duodenal function Microscopic anatomy of the distal stomach (body and antrum) and duodenum Neurophysiology of gastric emptying Putting it together: Neurohumoral control of gastroduodenal function during digestion Motility in between meals Regulating appetite Gastroduodenal response during meals Conclusions References 7 Small intestine anatomy and physiology Gross and microscopic anatomy Gross anatomy Microscopic anatomy Physiology Digestion and absorption FODMAPs Bile acids Motility of the small intestine Generation of migrating motor complex (MMC) Gut hormones Immune and barrier function Functional significance of small intestine from the perspective of neurogastroenterology and motility Conclusions Acknowledgment References 8 Colon and pelvic floor anatomy and physiology Anatomy and physiology of colon Colon anatomy Colon physiology Innervation of colon and rectum Enteric nervous system Interstitial cells of Cajal (ICC) Colon physiology and motility Anatomy and physiology of pelvic floor Pelvic floor physiology Supporting the pelvic organs Physiology of anal continence Physiology of defecation Conclusions Acknowledgment References Further reading 9 Investigation of the brain–gut axis Introduction Central nervous system Afferent Efferent Peripheral nervous system Sympathetic Parasympathetic Enteric nervous system Interactions between the microbiome and enteric nervous system Unraveling the pathophysiology of disorders of brain–gut interaction Brain–gut assessment in animals Stimulation and body behavior Abdominal withdrawal reflex Stimulation and abdominal electromyogram Neuronal tracing In vivo extracellular local field potentials recording of the brain Stereotactic injection of the brain Brain–gut axis assessment in humans Visceral sensitivity and central sensitization Cortical evoked potentials Esophageal evoked cortical evoked potentials (CEP) Rectal and anal cortical evoked potentials (CEP) after electrical stimulation Rectal and anal cortical evoked potentials (CEP) after rectal distension Motor evoked potentials Functional brain imaging Vagal tone measurement Conclusions References 10 Neurogastroenterology and motility laboratory: The nuts and bolts Introduction Why the need for a GI motility lab? A historical perspective A lab for clinical research, training, and practice Designing the GI motility lab Planning on the set-up Elements of a GI motility lab Equipment needed for a GI motility lab Procedural standards Billing and coding Staffing the GI motility lab Background Unmet needs of training during GI fellowship New curriculum for training: Summary of joint report of ANMS-ESNM task force Registry of GI motility labs Preparing and educating the patients Patient flow Educating the patients Conclusions Acknowledgment References Section B: Diagnostic tests and clinical approaches to neurogastroenterology and motility disorders Part I: Esophagus 11 Deglutition and oropharyngeal dysphagia Deglutition Oral phase Pharyngeal phase Oropharyngeal dysphagia Populations at risk Elderly Neurological and degenerative diseases Head and neck cancer Other structural causes Pathophysiology Diagnosis Screening Clinical assessment Instrumental evaluation Videofluoroscopy Oral phase Pharyngeal stage Fiberoptic endoscopic evaluation Pre-swallow position Post-swallow position High resolution manometry with intraluminal impedance Functional lumen imaging probe (FLIP) Complications Malnutrition and dehydration Respiratory complications Treatment Fluid/nutritional adaptation Eating modifications Swallow maneuvers and exercises Nutritional support Novel therapies Conclusions References 12 Functional dysphagia and globus Introduction Dysphagia Pathophysiology of dysphagia Differential diagnosis and approach to patients with dysphagia Functional dysphagia Definition Pathophysiology Diagnosis Other tests for esophageal motility disorders Automated integrated impedance manometry Impedance planimetry Treatment ( Table 3) Check and avoid motility-altering medications Try high dose acid suppression Consider therapies that address central processing and visceral sensitivity Consider empirical esophageal dilation Globus Epidemiology Clinical feature Pathophysiology Diagnostic approach Management ( Table 4) Proton pump inhibitors Speech therapy Psychological treatments Treatment for gastric inlet patch Summary and conclusions References 13 Esophageal body motility disorders Introduction Symptoms Diagnostic approach HREM procedure HREM analysis Normal interpretation of HREM Esophageal body disorders Disorders of outlet obstruction Achalasia EGJ outflow obstruction Major disorders of peristalsis Diffuse esophageal spasm Jackhammer esophagus Absent contractility Minor disorders of peristalsis Ineffective esophageal motility Fragmented peristalsis Miscellaneous pathologies Mixed connective tissue disease (MTCD) Opioid-induced esophageal dysfunction Infection related dysmotility Pharmacologic agents and toxin induced esophageal dysfunction Vascular artifacts on HREM Conclusions References 14 Achalasia Introduction Definition Epidemiology Pathophysiology Clinical presentation Diagnosis Endoscopy Barium esophagram Esophageal manometry Functional lumen imaging probe (FLIP) Treatment Pharmacological agents Botulinum toxin Pneumatic dilation Surgical myotomy Peroral endoscopic myotomy Esophagectomy Self-expanding metal stents (SEMS) Endoscopic sclerotherapy Immunosuppressive therapy Risk of esophageal carcinoma Treatment algorithm Conclusions References 15 Gastro-esophageal reflux disorders Introduction Definitions and epidemiology Pathophysiology Diagnosis Clinical diagnosis Upper gastro-intestinal endoscopy and esophageal biopsies Reflux monitoring Esophageal pH-monitoring Esophageal pH-impedance monitoring Symptom-reflux association Other tests Esophageal high resolution manometry Barium esophagogram Baseline and mucosal impedance Therapeutic management Lifestyle modifications Medical treatment Proton pump inhibitors Histamine-2 receptors antagonists (H 2 RAs) Potassium competitive acid blockers (PCAB) Other medications Anti-reflux surgery Minimally invasive procedures Conclusions Acknowledgments References 16 Barrett’s esophagus, sensation and reflux Introduction Relationship between GERD and BE Definition, pathophysiology, and prevalence of GERD Correlation between GERD severity and BE Symptomatology in GERD and BE Typical and atypical symptoms Correlation between symptom burden and presence of BE Motility function in BE patients Role of duodenal refluxate Symptom management in GERD and BE Medical therapy: Use of proton pump inhibitors Surgical anti-reflux treatment: Fundoplication Endoscopic therapy of BE Endoscopic mucosal resection (EMR) Radiofrequency ablation (RFA) Cryotherapy Argon plasma coagulation (APC) Conclusions References 17 Functional esophageal chest pain, functional heartburn and reflux hypersensitivity Introduction Functional esophageal chest pain Introduction Definition Epidemiology Pathophysiology Esophageal hypersensitivity Esophageal muscle contractions Decreased vagal tone Psychiatric comorbidities Clinical presentation Diagnosis Treatment Neuromodulators Complementary and alternative medicines Functional heartburn Introduction Definition Epidemiology Pathophysiology Esophageal hypersensitivity Visceral neuron dysfunction Dilated intercellular spaces and composition of refluxate Reactive oxygen species Disordered esophageal motility Psychiatric comorbidities Clinical presentation Diagnosis Treatment Promotility agents Neuromodulators Complementary and alternative medicines Reflux hypersensitivity Introduction Definition Epidemiology Pathophysiology Esophageal hypersensitivity Clinical presentation Diagnosis Treatment Acid suppression Anti-reflux surgery Neuromodulators Conclusions References Part II: Stomach 18 Gastroparesis Definition and epidemiology Definition Epidemiology Etiology Diabetic gastroparesis (DG) Idiopathic gastroparesis (IG) Postviral gastroparesis Medication-induced delayed gastric emptying Postsurgical gastroparesis Connective tissue disorders Pathophysiology of gastroparesis Clinical features Diagnosis History and physical examination Exclusion of mechanical obstruction Gastric motility assessment Wireless motility capsule (WMC) 13 C breath test Further tests Differential diagnosis Rumination syndrome Functional dyspepsia Cyclic vomiting syndrome (CVS) Management Diet and nutrition Medical treatments Prokinetics Antiemetics Analgesics and pain modulators Alternative medicine Intrapyloric botulinum toxin injection Surgical treatments Concluding remarks References 19 Functional dyspepsia Introduction Epidemiology Epidemiological factors Age Gender Body mass index Ethnicity Smoking Helicobacter pylori infection Dietary habits Socio-demographic factors Impact of FD Diagnosis and classification Diagnosis Classification Investigations Other diagnostic tests Pathophysiology Genetics Gut–brain axis dysregulation Gastric dysfunction Duodenal inflammation Helicobacter pylori Treatment Helicobacter pylori eradication Acid suppression therapy Prokinetics Anti-depressants Psychological therapy Herbal/complementary treatment Conclusions References 20 Nausea, belching, and rumination disorders Introduction Nausea Management of nausea Belching, supragastric belching and aerophagia Belching Supragastric belching Aerophagia Management of belching, supragastric belching and aerophagia Rumination syndrome Management of rumination syndrome Conclusions References 21 Investigation of small bowel motility Introduction Assessment of small bowel contractile activity Small bowel manometry Normal patterns of small bowel motility Abnormal patterns of small bowel motility Wireless motility capsule Use of imaging studies for assessment of small bowel motility Small bowel transit studies Breath tests Scintigraphy Wireless motility capsule (WMC) Conclusions References Further reading Part III: Small bowel 22 Small intestinal motility disorders Introduction Causes of small intestinal motility disorders Clinical features History taking and physical examination Investigations Conventional radiological investigations Small intestinal transit study Antrodudenal manometry Investigations for the involvement of other organs Investigations for SIBO Investigations for the etiology Small intestinal biopsy Nutritional assessment Treatment Nutritional and dietary management Pharmacotherapy Surgical treatment Supportive treatment Experimental treatment Conclusions References 23 Biliary motility and sphincter of Oddi disorders Introduction Functional gall bladder disorder Epidemiology and pathophysiology Diagnosis Treatment Sphincter of Oddi disorders Epidemiology and pathophysiology Clinical features Classification Sphincter of Oddi manometry Non-invasive prediction of SOD Management Endotherapy Predictors of response to endotherapy Pharmacotherapy Surgery Other treatments Summary References 24 Small intestinal bacterial and fungal overgrowth Small intestinal bacterial overgrowth Introduction, definition and epidemiology Etiopathophysiology of SIBO and related conditions ( Table 1) Gut anatomy and motility Gastric acidity and proton pump inhibitors Immune function and inflammation Other conditions Consequences of SIBO Clinical manifestations of SIBO Diagnostic tests for SIBO ( Table 2) Presumptive diagnosis and empiric antibiotic treatment Small bowel aspirates and cultures Breath testing Newer techniques Treatment of SIBO Antibiotic therapy Non-pharmacologic therapies Prevention of recurrence Nutritional support Conclusions Small intestinal fungal overgrowth Introduction Pathophysiology and risk factors for SIFO Clinical manifestations of SIFO Diagnosis of SIFO Treatment of SIFO Conclusions Conflict of interest References 25 Investigations for dietary carbohydrate malabsorption and gut microbiota Introduction Hydrogen breath tests Technique of breath test Patient preparation Lactose malabsorption Lactose hydrogen breath test and tolerance test Fructose malabsorption Fructose hydrogen breath test Hydrogen breath tests with more complex carbohydrates Investigations for gut microbiota Sample collection for studying gut microbiota Gut aspirate Mucosal biopsy Culture-based methods Quantitative culture of gut aspirate Culturomics Molecular methods Polymerase chain reaction (PCR) Real time PCR Next generation sequencing Interpretation of the NGS data Breath tests for diagnosis of SIBO Conclusions References 26 FODMAPs and carbohydrate intolerance Introduction Heterogeneity of dietary carbohydrates Concepts of short-chain carbohydrate malabsorption and intolerance Clinical approach to restricting dietary short-chain carbohydrates in IBS The FODMAP diet Evidence-base for the FODMAP dietary program Who should deliver the FODMAP diet Relevance across the world Predictors of response and non-response Reasons for and approach to non-response Risks of a FODMAP diet Psychological risks Nutritional risks Risks to the structure and function of the microbiota FODMAP diet in the management algorithms for IBS Other indications for a FODMAP diet Consideration of specific short-chain carbohydrates Fructose and sorbitol intolerance Brush border hydrolase deficiencies Lactase deficiency Deficiency of other brush border hydrolases in the small intestine Conclusions Acknowledgments References 27 Food allergy and food hypersensitivity Types of food allergies Diagnosis of IgE-mediated food allergy Management of food allergy Food induced GI symptoms and GI diseases Overlap of IBS and food hypersensitivity Specific food-related hypersensitivity Wheat and gluten-related disorders Wheat allergy Celiac disease Dermatitis herpetiformis Non-celiac gluten sensitivity Prevalence of NCGS Clinical manifestations Pathophysiology of NCGS Investigating patients who are suspected to have gluten related disorders Overlap between IBS and gluten-related disorders Management of NCGS Predictors of response to GFD in patients with IBS Conclusions Acknowledgment Conflicts of Interest References 28 Investigation of anorectal motility ☆ Introduction Anatomy overview Pelvic floor Anorectum Function: Maintenance of normal defecation Disorders of defecation Investigations Anorectal manometry Normal values and interpretation Resting pressure Increased/decreased resting pressure Squeeze pressure Cough reflex Response to straining Balloon expulsion test Recto-anal inhibitory reflex (RAIR) Rectal sensation Barostat Imaging studies Endoanal ultrasound Pathology with circular muscle integrity Pathology with loss of circular muscle integrity Defecography Barium defecography using fluoroscopy MRI Normal defecography Abnormal findings Dyssynergic defecation: Rectocele Enterocele Intussusception/rectal prolapse Descending perineum syndrome Clinical considerations Conclusions References Part IV: Colon and anorectum 29 Investigation of colonic motility Purpose of colonic motility function Assessment of colonic motility Radiopaque markers Scintigraphy Wireless motility capsule (SmartPill®) Manometry High amplitude propagating contractions (HAPC) Simultaneous pressure waves Cyclic propagating motor pattern Low amplitude single propagating motor patterns Haustral activity Barostat Electromagnetic capsule Magnetic resonance imaging What have we learnt about colonic motility and its possible function and usefulness over the last few years? References 30 Irritable bowel syndrome Introduction Epidemiology Definition Pathophysiology The brain–gut axis Gut microbiota Diet and IBS Inflammation and post-infectious IBS Colonic bile acid Genetic factors Diagnosis Treatment IBS-diarrhea IBS-constipation Abdominal pain Global symptoms Conclusions Conflict of interest References 31 Chronic constipation Introduction and epidemiology Pathophysiological subtypes of constipation Diagnosis of constipation Clinical evaluation Management of constipation First-line therapy When first-line fails Second-line therapy Refractory constipation Is surgery the last resort for constipation? Conclusion References 32 Dyssynergic defecation and defecation disorders Introduction Dyssynergic defecation Definition and epidemiology Pathophysiology Diagnosis Symptoms evaluation Digital rectal examination Balloon expulsion test Anorectal manometry Defecography Treatment Other defecations disorders Solitary rectal ulcer syndrome (SRUS) Definition and pathophysiology Diagnosis Treatment Rectal prolapse and intussusception Definition and pathophysiology Diagnosis Treatment Descending perineum syndrome Definition and pathophysiology Diagnosis Treatment Rectocele Definition and pathophysiology Diagnosis Treatment Conclusions References 33 Opioid-induced bowel disorder and narcotic bowel syndrome Introduction Prevalence of opioid use Opioid-induced bowel disorders Prevalence of opioid-induced bowel disorders and opioid-induced constipation Impact of opioid-induced bowel disorders Pathophysiology of opioid-induced-constipation Assessment of opioid-induced constipation Specific treatment of opioid-induced-constipation Laxatives Peripherally acting μ -receptor antagonists Methylnaltrexone (Relistor®, Salix) Naloxegol (Movantik®, AstraZeneca) Naldemedine (Symproic®, Shionogi) Lubiprostone (Amitiza®, Takeda) Prucalopride (Motegrity®, Shire) Naloxone Alvimopan (Entereg®, Merck) Guidelines for the management of opioid-induced constipation Narcotic bowel syndrome Epidemiology Pathophysiology Diagnosis Management References 34 Functional diarrhea Introduction Epidemiology of functional diarrhea Differential diagnosis of functional diarrhea Diagnostic approach History Physical examination Diagnostic tests Bile acids Breath test Pathophysiology Treatment Diet Fiber Opiates Bile acid binders 5HT 3 receptor antagonists Tricyclic antidepressants (TCA) Probiotics Antibiotics Conclusions References 35 Fecal incontinence Introduction Definition Epidemiology and risk factors Healthcare seeking Symptom severity and quality of life assessments Prognosis Pathophysiology Diagnostic assessment Digital rectal examination High-resolution anorectal manometry Imaging Nerve conduction studies Emerging diagnostic tests Treatment and emerging therapies Conservative medical management Biofeedback therapy Injection of bulking agents Neuromodulation Surgical techniques and evolving therapies Conclusions Conflict of interest References 36 Anorectal pain Overview of clinical syndromes Functional anorectal pain Definition Epidemiology Pathophysiology and predisposing conditions Clinical presentation Investigations Management Proctalgia fugax Definition Epidemiology Pathophysiology and predisposing conditions Clinical presentation Investigations Management Coccygodynia Pudendal neuralgia Competing interests References 37 Biofeedback therapy Introduction Biofeedback therapy: Devices and protocol Biofeedback therapy technique for dyssynergic defecation Step 1: Education on anorectal anatomy and defecation physiology Step 2: Identify and target the defecation problem(s) individually Ineffective rectal propulsion Paradoxical contraction or inadequate anal sphincter relaxation Impaired rectal sensation Step 3: Maintenance therapy Efficacy of biofeedback therapy for dyssynergic defecation Biofeedback therapy for fecal incontinence Biofeedback therapy technique for fecal incontinence Step 1: Education and setting the treatment goal Step 2: Identify and correct the individual incontinence mechanism Weak sphincter and pelvic floor muscles (poor strength and endurance) Abnormal anorectal coordination Poor or delayed response to stool sensation Abnormal rectal sensation Step 3: Maintenance treatment Efficacy of biofeedback therapy for fecal incontinence Conclusions References Further reading 38 Neurogastroenterology and motility disorders in pediatric population Introduction Esophageal motility disorders Gastroesophageal reflux Epidemiology Pathophysiology Diagnosis Clinical profile Investigations Upper gastrointestinal endoscopy pH and intraluminal impedance recording Other investigations Management Non-pharmacological treatment options Education and lifestyle modification Feeding modification Positioning Pharmacological management Anti-reflux surgery Transpyloric feeds Complications Prognosis Achalasia Epidemiology Pathophysiology Diagnosis Clinical profile Esophageal high resolution manometry (HRM) Barium swallow Management Pharmacological treatment Surgical management Impact and complications Motility disorders of the stomach Gastroparesis Epidemiology Pathophysiology Diagnosis Clinical profile Gastric motility studies Treatment Pharmacological management Non-pharmacological treatment options Prognosis and outcome Motility disorders in the small intestine Chronic intestinal pseudo-obstruction Epidemiology Diagnosis Clinical profile Histopathology Radiology Motility investigations Management Motility disorders in the colon and anorectum Hirschsprung’s disease Etiology and pathogenesis Clinical picture Diagnosis Rectal suction biopsy Anorectal manometry Contrast studies Management Outcome Slow transit constipation Clinical features Pathophysiology Investigations Colonic transit studies Management Anorectal dysfunction Other gastrointestinal disorders with motility problems Post-surgical problems Drug induced motor problems Motor disorders associated with systemic diseases Future perspectives Intestinal transplantation Stem cell transplant Novel pharmacological therapies Manipulation of intestinal microbiota Electrical pacing Summary References Part V: Pediatric neurogastroenterology and motility disorders 39 Pediatric functional gastrointestinal disorders Introduction Rome IV criteria for diagnosis of pediatric FGID Childhood functional GI disorders: Neonate/toddler Infant regurgitation Infant colic Infant dyschezia Functional diarrhea Childhood functional GI disorders: Child/adolescent Functional nausea and vomiting disorders Functional nausea and functional vomiting Aerophagia Functional abdominal pain disorders Functional dyspepsia Irritable bowel syndrome Abdominal migraine Functional abdominal pain—NOS Functional defecation disorders Non-retentive fecal incontinence Childhood functional GI disorders: Infant/toddler/child/adolescent Rumination syndrome Cyclic vomiting syndrome (CVS) Functional constipation Integrative therapy Transitioning Conclusions References Section C: Biopsychosocial and systemic neurogastroenterology and motility 40 Multicultural factors in the treatment of patients with functional gastrointestinal disorders Introduction Case presentation FGIDs Case presentation Culture and patient explanatory models Interpretation of symptoms Case discussion Traditional Chinese medicine (TCM) Psychosocial factors Case discussion Doctor–patient therapeutic partnership Work in an environment of uncertainty Cultural competence Treatment Case discussion Case discussion Treatment Diet Other non-pharmacological treatments Pharmacological therapy Conclusions References 41 Behavioral and non-pharmacological management of functional gastrointestinal disorders Introduction Yoga and exercise Yoga Exercise Psychological therapies Rationale and principle Effects on GI symptoms and daily function Durability Comparison of delivery options Mechanism of symptom improvement Acupuncture Moxibustion Herbal medications Cannabis Summary References 42 Probiotics and prebiotics, including fibers and medicinal foods Introduction Definition and Mechanism of action Probiotics Prebiotics Synbiotics Fiber Medical foods Peppermint oil Serum-derived bovine immunoglobulin/protein isolate VSL #3 PO and caraway oil Clinical evidence in functional gastrointestinal disorders Irritable bowel syndrome (IBS) Probiotics Prebiotics Synbiotics Fiber Medical foods Peppermint oil Serum-derived bovine immunoglobulin/protein isolate VSL #3 Functional dyspepsia Caraway seed oil and peppermint oil Conclusions References 43 Systemic disorders that affect gastrointestinal motility Introduction Systemic disorders associated with disturbed motility Diabetes mellitus Background Diabetic gastroparesis Other motility disorders Thyroid disorders Background Effects of hyperthyroidism on GI motility Effect of hypothyroidism on GI motility Systemic sclerosis Background Esophageal disorders Small bowel disorders Dysmotility in other parts of the GI tract Systemic lupus erythematosus (SLE) Other collagen vascular disorders Amyloidosis Background GI dysmotility associated with amyloidosis Sarcoidosis Background GI dysmotility associated with sarcoidosis Hypermobile Ehlers-Danlos syndrome and benign joint hypermobility syndrome Background GI manifestations Parkinson disease Background Gut-brain link GI manifestations Conclusions Acknowledgment References Index A B C D E F G H I J L M N O P R S T U V W Y Back Cover __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.