Gastrointestinal Motility Disorders, An Issue of Gastroenterology Clinics (The Clinics: Internal Medicine)

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. Cover......Page 1 Preface......Page 2 Overview of Neurogastroenterology-Gastrointestinal Motility and Functional GI Disorders: Classification, Prevalence, and Epidemiology......Page 4 Classification of Neurogastroenterology Disorders......Page 5 Epidemiology......Page 8 Esophageal Disorders......Page 9 Gastroduodenal Disorders......Page 10 Bowel Disorders Affecting Small Intestine and Colon......Page 11 Summary......Page 13 References......Page 15 Enteric nervous system......Page 18 Motor patterns......Page 21 Extrinsic Efferents......Page 22 Mechanosensation......Page 23 Chemosensation......Page 24 Interstitial cell of Cajal......Page 25 Smooth muscle......Page 27 Immune cells......Page 28 References......Page 29 Director......Page 33 General Comments on the Gastrointestinal Motility Laboratory......Page 34 The Gastrointestinal Motility Laboratory......Page 35 The Gastrointestinal Motility Laboratory Room......Page 36 Equipment......Page 37 Procedures......Page 39 Gastrointestinal motility nurse or technician......Page 41 Billing and Coding......Page 44 Scheduling coordinator......Page 43 Registry of Gastrointestinal Motility Laboratories......Page 45 References......Page 47 Approach to the Patient Presenting with Dysphagia......Page 48 Technical Aspects......Page 49 Role in Studying Esophageal Function......Page 50 Future Directions in Impedance......Page 54 Technical Aspects......Page 56 Role in Studying Esophageal Function......Page 58 Future Directions in High-Resolution Manometry......Page 59 Technical Aspects......Page 62 Role in Studying Esophageal Function......Page 64 References......Page 65 Esophageal Motor and Sensory Disorders: Presentation, Evaluation, and Treatment......Page 69 Are symptoms present that suggest an esophageal motor or sensory disorder?......Page 70 Have more common causes for these symptoms been excluded?......Page 72 Testing for Esophageal Motor Disorders......Page 74 Testing for Esophageal Sensory Disorders......Page 77 Is the sensorimotor disorder idiopathic, or does it result from another condition?......Page 78 Are there additional disorders present to cause or modulate symptoms?......Page 79 What therapies should be used in patients with sensorimotor esophageal disorders?......Page 80 Treatment of Motor Disorders......Page 81 Treatment of Sensory Disorders......Page 84 What are the causes of persistent or recurrent symptoms after treatment?......Page 85 Summary......Page 86 References......Page 87 Definition......Page 92 Prevalence and Incidence......Page 93 Risk Factors......Page 94 Clinical presentations......Page 95 Upper Endoscopy......Page 96 Esophageal pH Monitoring......Page 98 Barium Esophagram......Page 99 Complications......Page 100 Peptic Esophageal Strictures......Page 101 Extraesophageal Manifestations......Page 102 Proton Pump Inhibitors......Page 103 Treatment of Complicated Gastroesophageal Reflux Disease and its Extraesophageal Presentations......Page 104 Safety Concerns......Page 105 Endoscopic treatment......Page 107 Surgical management......Page 108 References......Page 110 The Gastroesophageal Junction High-Pressure Zone......Page 115 Gastroesophageal Reflux Disease......Page 116 Hiatal Hernia......Page 117 Ultrasound Technology......Page 118 The Normal Overlapping Gastroesophageal Sphincters......Page 119 Gastroesophageal Reflux Disease......Page 123 Endoscopic Treatments for Gastroesophageal Reflux Disease......Page 124 Surgical Treatments for Gastroesophageal Reflux Disease......Page 125 The Biomechanics of the Gastroesophageal Junction High-Pressure Zone......Page 126 Summary......Page 129 References......Page 130 Clinical Manifestations......Page 132 Etiology......Page 133 Pathogenesis......Page 134 Epidemiology......Page 136 Epidemiology......Page 137 Other disorders with isolated gastric motor dysfunction......Page 138 Nongastrointestinal disorders with associated delays in gastric emptying......Page 139 Initial Evaluation......Page 141 Demonstration of Gastric Functional Impairment......Page 142 Dietary and Nonmedicinal Measures......Page 145 Metoclopramide......Page 146 Erythromycin......Page 147 Domperidone......Page 148 Antiemetic Medication Therapy......Page 149 Endoscopic Treatment......Page 151 Gastric electrical stimulation......Page 152 Other operative interventions......Page 153 Controversies and Future Directions......Page 154 References......Page 155 Functional Dyspepsia: Mechanisms of Symptom Generation and Appropriate Management of Patients......Page 161 Mechanisms in functional dyspepsia......Page 162 The association between symptoms and pathophysiology in dyspepsia......Page 165 General Measures......Page 167 Prokinetic Agents......Page 168 Antidepressants and Behavioral Approaches......Page 169 References......Page 172 Gastrointestinal Symptoms......Page 177 Extraintestinal Symptoms and Comorbid Disorders......Page 179 Symptom Severity......Page 180 Diagnostic evaluation of irritable bowel syndrome......Page 181 Diet......Page 183 Laxatives......Page 184 Alosetron......Page 187 Tricyclic antidepressants......Page 188 Antibiotics......Page 189 Novel Drugs in Development for Irritable Bowel Syndrome......Page 190 Complementary and Alternative Medicine......Page 191 References......Page 192 Epidemiology......Page 198 Pathophysiology......Page 199 Pathophysiology of Slow Transit Constipation......Page 201 Clinical Features......Page 203 Colonic Transit Study......Page 205 Anorectal Manometry......Page 206 Defecography......Page 208 Fluid Intake and Exercise......Page 209 Laxatives......Page 212 Slow Transit Constipation......Page 213 Dyssynergic Defecation......Page 214 Stool Impaction and Refractory Constipation Including Surgery......Page 215 Evidence-Based Summary for the Treatment of Constipation......Page 216 References......Page 217 Forward pacing......Page 223 Gastric Electrical Stimulation......Page 224 Single-channel stimulation......Page 225 Multichannel stimulation......Page 227 Backward (or reverse) pacing......Page 228 Forward intestinal pacing......Page 229 Backward intestinal pacing......Page 230 Long-pulse and low-frequency stimulation......Page 231 Short-pulse and high-frequency stimulation......Page 232 Treatment of Obesity......Page 234 Treatment of Fecal Incontinence......Page 236 Future directions and developments......Page 238 References......Page 239 Bacterial Overgrowth in Established Motility Disorders......Page 245 Dysmotility and Bacterial Overgrowth in Common Systemic Disorders......Page 246 The Role of Bacteria in Irritable Bowel Syndrome......Page 247 What Is The Evidence for Immune Activation and Inflammation in Irritable Bowel Syndrome?......Page 248 Are There Qualitative or Quantitative Changes in The Enteric Flora in Irritable Bowel Syndrome?......Page 250 Will Altering The Flora with Antibiotics or Probiotics Have An Impact innbspIrritable Bowel Syndrome?......Page 251 Is There a Diagnostic Category that Lies Between Irritable Bowel Syndrome and Chronic IntestinalnbspPseudo-Obstruction?......Page 253 References......Page 254 Motor Disorders of the Esophagus......Page 259 Tracheoesophageal Fistula and Atresia......Page 260 Chronic Intestinal Pseudo-Obstruction Syndrome......Page 261 Childhood Constipation and Implications for Colon Motility Disorders in Adults......Page 265 Hirschsprung’s Disease......Page 267 References......Page 270