Gastrointestinal Motility. Tests and Problem-Oriented Approach

Transcription

1 Gastrointestinal Motility Tests and Problem-Oriented Approach

2 Gastrointestinal Motility Tests and Problem-Oriented Approach Edited by University of Iowa College of Medicine Associate Editors Jeffrey L. Conklin University of Iowa College of Medicine Frederick C. Johlin University of Iowa College of Medicine Joseph A. Murray Mayo Clinic Rochester, Minnesota Konrad S. Schulze-Delrieu The University of Iowa College of Medicine and Robert W. Summers The University of Iowa College of Medicine Springer Science+Business Media, LLC

3 Library of Congress Cataloging-in-Publ ication Data Gastrointestinal motility : tests and problem-oriented approach / edited by Satish S.C. Rao... [et a l. l. p. cm. "Proceedings of the Sixth Symposium on Gastrointestinal Motility, held March 13-15, 1998 in Dana Point, Ca 1ifornia" T.p. verso. Includes bibliographical references and index. ISBN ISBN (ebook) DOI / Gastrointestinal system Motility Disorders Congresses. I. Rao, Satish S. C. II. Symposium on Gastrointestinal Motility (6th : 1998 : Dana Point, Calif.) [DNLM: 1. Gastrointestinal Motility Congresses. 2. Diagnostic Techniques, Digestive System Congresses. 3. Digestive System Diseases physiopatho 1 ogy Congresses. 4. Hypera1gesia.Congresses. WI 140 G ] RC811.G '3 dc21 DNLM/DLC for Library of Congress CIP Including proceedings of the Sixth and Seventh Symposia on Gastrointestinal Motility, held March 13-15,1998, in Dana Point, California, and March 19-21, 1999, in Cancün, Mexico, respectively ISBN Springer Science+Business Media New York Originally published by Kluwer Academic / Plenum Publishers in 1999 Softcover reprint of the hardcover 1st edition A CLP. record for this book is available from the Library of Congress. All rights reserved No part of this book may be reproduced, stored in a retrieval system, Or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

4 PREFACE Gastrointestinal motility has evolved from an esoteric laboratory tool into a sophisticated diagnostic technique that is now widely used clinically to guide in management of complex gastrointestinal problems. Today, it is the most rapidly growing subspecialty within gastroenterology. Previously, many of the gastrointestinal motility problems were either ignored or attributed to a disturbance of "psyche." But with the growing knowledge and understanding of how a dysfunction of the gastrointestinal muscle and nerves can cause disease, we are at the threshold of a revolution in our approach to the diagnosis and treatment of gastrointestinal motility disorders. The purpose of this book is to serve as a useful, up-to-date reference manual and guide for the diagnostic and therapeutic approach towards common adult and pediatric gastrointestinal motility problems. In order to enhance the understanding of these disorders, a problem-oriented approach has been chosen, and wherever possible the authors have provided clinical case scenarios to illustrate their message. The emphasis has been on how to diagnose and treat motility disorders rather than to provide an encyclopedic information. The reference list at the end of each chapter should enable the enthusiast to seek further information. Some of the material presented in this book has been derived from the proceedings of the annual University ofiowa College of Medicine GI Motility Symposia. Motility largely refers to the movement of muscles that line the gastrointestinal conduit. But the regulation of this movement involves many other components, principally the nerves, reflexes, visceral sensations, and neurohormones. Hence, this subspecialty is now more aptly described as neurogastroenterology and gastrointestinal motility. In the following chapters, we present some new information regarding the genesis, evaluation, and management of visceral hyperalgesia- the key problem which causes pain and discomfort related to several gastrointestinal organs. Because motility is a visual science, generous illustrations and tables have been provided throughout the text in order to enhance the understandingof common problems. We hope that this book will serve as useful reading material for practitioners and trainees in gastroenterology, as well as for radiologists, internists, family practitioners, and general surgeons, each of whom encounter patients with motility problems on a daily basis. The "tests" section can be particularly useful for nurses and technical personnel that are involved in gastrointestinal motility. These diagnostic tests are evolving and there is no standardized approach. But the authors-who are experts in their field- have provided a succinct, practical, and balanced approach that can be used in any laboratory. We believe v

5 vi Preface that users will gain information that will enable them to provide better care for their patients. Given the increasing impositions of clinical work, and constraints on academic time, editing this book has not been easy. But this task was accomplished, because of the dedicated and uncompromising support of my wife Sheila, my children Priyanka, Anita and Nikilesh, and my secretary, Ms. Susie McConnell. I would like to especially thank the associate editors for helping me see the light when I was blindfolded, and each of the authors who have expended their valuable time in the service of humanity. Plenum Publishers, in particular Ms. Mary Ann McCarra and Jonathan Harmon, deserve special credit for their painstaking and meticulous efforts to produce this book in a timely fashion. Clearly, you the reader can only judge the quality of this work, and I hope you like it. Salish S. C. Rao

6 CONTENTS Section 1. Tests of Gastrointestinal Motility, Associate Editor: I. Videofluoroscopic Assessment of Swallowing Bruce P. Brown 2. Esophageal Manometry Jeffrey L. Conklin and Joseph A. Murray Hour Ambulatory ph Test Joseph A. Murray 4. Scintigraphic and Ultrasound Evaluation of Gastric Motility Bruce P. Brown Electrogastrography Mark Pimentel and Henry C. Lin 6. Antroduodenojejunal Manometry Robert W. Summers and 7. Sphincter of Oddi Manometry Glen A. Lehman 8. Colonic Transit and Anorectal Manometry 9. Defecography and Anal Endosonography Retta E. Pelsang Section 2. Clinical Approach to Disorders of Oropharyngeal and Esophageal Motility, Associate Editor: Konrad S. Schulze-Delrieu 10. Oropharyngeal Dysphagia Konrad S. Schulze-Delrieu and Bruce Brown vii

7 viii Contents 11. Esophageal Dysphagia Jeffrey L. Conklin 12. Typical and Atypical Manifestations of Gastroesophageal Reflux Disease Donald O. Castell Section 3. Clinical Approach to Disorders of Gastric and Small Intestinal Motility, Associate Editor: Robert W. Summers 13. Disorders of Gastric Motility and Emptying Konrad S. Schulze-Delrieu 14. Disorders of Small Intestinal Motility Robert W. Summers 15. Post Surgical Gastric Dysmotility Syndromes John H. Pemberton 16. Dyspepsia and Upper Gastrointestinal Motility in Children Carlo Di Lorenzo Prokinetics Joseph A. Murray Section 4. Clinical Approach to Disorders of Pancreas and Biliary Motility, Associate Editor: Frederick C. Johlin 18. Gallbladder Dysmotility Glen A. Lehman 19. Sphincter ofoddi and Pancreatic Sphincter Dysmotility Frederick C. Johlin Section 5. Clinical Approach to Disorders of Colon and Anorectal Motility, Associate Editor: Jeffrey L. Conklin 20. Constipation Fecal Incontinence John H. Pemberton 22. Biofeedback Therapy for Constipation and Fecal Incontinence 23. Pediatric Colorectal Disorders Carlo Di Lorenzo 24. Bloating and Gas William J. Snape, Jr

8 Contents Ix Section 6. Gastrointestinal Visceral Pain, Associate Editor: Joseph A. Murray 25. Neurophysiology of Visceral Pain G. F. Gebhart Clinical Evaluation of Visceral Pain Clinical Approach to Non-Cardiac Chest Pain Donald O. Castell 28. Clinical Approach to Non-Ulcer Dyspepsia Mark Pimentel and Henry C. Lin 29. Clinical Approach to Colorectal Pain William J. Snape, Jr. Contributors Index