Mark Fox is at the Abdominal Center: Gastroenterology, St. Claraspital, CH-4016 Basel, Switzerland, and is Professor at the University of Zürich, Zürich, Switzerland. He served as Chair of the International Working Group for Disorders of Gastrointestinal Motility and Function from 2014–2017.
Symptoms related to abnormal gastrointestinal motility and function can occur from the moment food is swallowed to the time stool is passed into the toilet. A recent UEG survey indicated that dysphagia, heartburn, bloating, abdominal pain and changes to bowel habit are each reported by 5–15% of the general population.1 These symptoms are frequent reasons for seeking medical attention from general physicians and for referral to specialist gastroenterologists. Most patients with these symptoms do not have neoplasia, infection or inflammation on initial investigation, but rather so-called functional gastrointestinal symptoms.2,3
For patients with mild symptoms, negative tests provide reassurance and simple, symptomatic management might be all that is required (e.g. acid suppression, stool regulation). However, for those with severe symptoms that persist on therapy, ruling out life-threatening disease is not sufficient, and referral to the neurogastroenterology and motility (NGM) laboratory for physiological measurements is often indicated.
Clinical investigations aim to explain the cause of symptoms and establish a diagnosis that can guide rational treatment. Until recently, it could be argued that manometry, scintigraphy, breath tests and related tests rarely provided this information. As a result, only patients with suspected major motility disorders (e.g. achalasia, severe reflux disease or faecal incontinence) were routinely referred to the NGM laboratory for tests. Technological advances, such as high-resolution manometry (HRM), now provide objective measurements not only of motility, but also of function in terms of the movement (and digestion) of ingested material within the gastrointestinal tract. Furthermore, the ability to associate events (such as bolus retention, reflux or gas production) with symptoms provides an indication of visceral sensitivity and can identify what is causing patient complaints.
Here, I discuss frequent mistakes in clinical investigation of gastrointestinal motility and function based on a series of consensus documents published by members of the International Working Group for Disorders of Gastrointestinal Motility and Function.
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About the Author
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Your clinical investigation of gastrointestinal motility and function briefing
Websites
Online courses
Mistakes in…
- Mistakes in gastro-oesophageal reflux disease diagnosis and how to avoid them.
- Mistakes in irritable bowel syndrome and how to avoid them.
- Mistakes in paediatric functional constipation diagnosis and treatment and how to avoid them.
- Mistakes in dyspepsia and how to avoid them.
UEG Week
- ‘Optimising the diagnosis of IBS’ session at UEG Week 2017.
- ‘Rome IV: New diagnostic criteria for functional GI disorders’ session at UEG Week 2016.
- ‘The Rome IV criteria for functional GI disorders: What's new for the clinican?’ presentation at UEG Week 2016.
Standards and Guidelines
- Carrington E, et al. Expert consensus document: Advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol 2018; 15: 309-323.
- Keller J, et al. Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol & Hepatology 2018: 15; 291–308.
- Kahrilas P, et al. Expert consensus document: Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes. Nat Rev Gastroenterol Hepatol 2017; 14: 677-688.
- Savarino E, et al. Expert consensus document: Advances in the physiological assessment and diagnosis of GERD. Nat Rev Gastroenterol Hepatol 2017; 14: 665-676.
- Allam A, et al. NICE Quality Standard Irritable bowel syndrome in adults. 2016.
- Beresford L, et al. Constipation in children and young people. 2014.
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References
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