Gastrointestinal Motility Disorders: Diagnosis and Management

Dear Colleagues,

Gastrointestinal motility disorders, particularly those that involve the stomach and  the small bowel, are responsible for some of the most pervasive and difficult-to-control diseases.  If we look at reflux disease, it is largely caused by the malfunction of gastric motility. Similar comments can be made for dyspepsia and gastroparesis, which have recently been determined to be the same disease at different ends of the spectrum. Other diseases have characteristic signatures of disordered small bowel or gastric motility, which can be used to diagnose them. Examples of this include adenomyosis and endometriosis. The same motility issue is responsible for problems with fertility. Gastroparesis can be subdivided into three basic groups, which include normal corpus contraction, hypocorpus contraction, and hypernormal or functional outlet obstruction of the pylorus. With the ability to use current tools to place these diseases in separate subtypes comes the ability to treat and cure them. Gastroparesis has been thought to be incurable; however, if we look at the hypernormal or the normal type associated with reflux disease, we know that they account for approximately 50% of gastroparesis and can be completely cured. The problem is proper identification. We have tools, including Electrogastrography and electroviscerography, that are capable of not only diagnosing abnormal motility but subtyping it. Additionally, the hyponormal subtype can be caused by things like hyper- or hypothyroidism, diabetes, and collagen vascular disease. Once again, by using EGG or EVG we can make that diagnosis and therefore cure the underlying problem by curing the causative disease. Studying gastric motility can also help us avoid complications caused by different surgical procedures, such as bariatric surgery. Most do not realize that there is a 40% complication rate of refractory reflux and up to a 6% rate of leakage from the staple line, all caused by an underlying, unrecognized gastric motility disorder. EGG can detect this; the patient can then be treated preventatively and avoid this complication. My goal is to make those in clinical medicine and surgery aware of the potential of these tools in order to improve the lives of the hundreds of millions of people who suffer from these diseases.

Dr. Mark Noar
Guest Editor

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• gastrointestinal motility disorders
• diagnosis
• achalasia
• non-achalasia esophageal motility disorders
• dyspepsia
• gastroparesis
• chronic intestinal pseudo-obstruction
• irritable bowel syndrome
• chronic constipation
• endoscopy