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

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