Disorders of gastrointestinal motility: Towards a new classification (original) (raw)
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Disorders of gastrointestinal motility: Towards a new classification 1
Journal of Gastroenterology and Hepatology, 2002
can be learnt from the patient. In the last decade, the 'Delphic' technique has been used to try and define combinations of symptoms in the belief, or hope, that specific symptom patterns correspond to specific underlying disorders. The 'Rome criteria' for the definition and diagnosis of functional gastrointestinal disorders have received much attention. Unfortunately, consensus of opinions by experts does not, per se, confer scientific validity. Evidence-based medicine requires not consensus, but evidence. We have reappraised the problem of classifying motor disorders by relying on what can be established by the detection of abnormal motor patterns, usually, but not invariably, associated with the altered movement of the contents of the digestive tube. In some, but not yet all, disorders, this approach is reinforced by identification of underlying pathological change in enteric innervation or musculature. While we remain aware that the association between symptoms-the perception that drives patients to seek help-and motor abnormalities is not always clear, we have taken the view that objectively reproducible alterations in organ function provide a robust basis for taxonomy. Such problems are not unique to gastroenterology; as an example, the association between dyspnea and specific pulmonary pathologies is not always clear, but dyspnea is a useful indication of abnormal respiratory function indicative of disease. Clinicians may feel dismayed that we have not elected to define two commonly used terms: 'functional dys
Nature reviews. Gastroenterology & hepatology, 2018
Disturbances of gastric, intestinal and colonic motor and sensory functions affect a large proportion of the population worldwide, impair quality of life and cause considerable health-care costs. Assessment of gastrointestinal motility in these patients can serve to establish diagnosis and to guide therapy. Major advances in diagnostic techniques during the past 5-10 years have led to this update about indications for and selection and performance of currently available tests. As symptoms have poor concordance with gastrointestinal motor dysfunction, clinical motility testing is indicated in patients in whom there is no evidence of causative mucosal or structural diseases such as inflammatory or malignant disease. Transit tests using radiopaque markers, scintigraphy, breath tests and wireless motility capsules are noninvasive. Other tests of gastrointestinal contractility or sensation usually require intubation, typically represent second-line investigations limited to patients with...
Neurogastroenterology & Motility, 2013
Background Abdominal pain is common in patients with functional bowel disorders (FBDs). The aim of this study was to characterize the predominant sites of abdominal pain associated with FBD subtypes, as defined by the Rome III criteria. Methods A total of 584 consecutive patients attending FBD consultations in a tertiary center participated in the study. Stool form, abdominal pain location (nine abdominal segments), and pain intensity (10-point Likert scale) during the previous week were recorded. Logistic regression analysis was used to characterize the association of abdominal pain sites with specific FBD subtypes. Key Results FBDs were associated with predominant pain sites. Irritable bowel syndrome (IBS) with constipation was associated with pain in the left flank and patients were less likely to report pain in the right hypochondrium. Patients with functional constipation reported pain in the right hypochondrium and were less likely to report pain in the left flank and left iliac site. IBS with alternating constipation and diarrhea was associated with pain in the right flank, and unsubtyped IBS with pain in the hypogastrium Patients with functional abdominal pain syndrome reported the lower right flank as predominant pain site. Patients with unspecified FBDs were least likely to report pain in the hypogastrium. Patients with functional diarrhea, IBS with diarrhea, or functional bloating did not report specific pain sites. Conclusions & Inferences The results from this study provide the basis for developing new criteria allowing for the identification of homogeneous groups of patients with non-diarrheic FBDs based on characteristic sites of pain.
Mistakes in clinical investigation of gastrointestinal motility and function and how to avoid them
2018
or a urea breath test should be considered if Helicobacter pylori infection is suspected. Additionally, stool calprotectin levels are used to screen for inflammatory bowel disease (IBD) and are also raised in many cases of advanced neoplasia. Prospective trials and meta-analyses indicate that the presence of alarm symptoms is associated with a 5–10% risk of serious disease, compared with a 1–2% risk in patients without alarm symptoms. 4 Early endoscopy is indicated to exclude ‘organic’ pathology in this Mistake 1 Failing to perform endoscopy and/or imaging in the presence of alarm features The initial assessment of patients with gastrointestinal symptoms must identify ‘alarm features’ that could indicate the presence of neoplasia, ulceration or inflammation in the digestive tract and require urgent endoscopy and/or imaging (see list in figure 1). In practice, identification is based on clinical history and the results of laboratory investigations, including a full blood count, clini...
2009
Imprecise characterization of complaints of the upper and lower gastrointestinal (GI) tract puts patients at risks of either a delayed diagnosis or misdiagnosis and contributes to an increase in the overall direct and indirect costs of the health system. the current scenario in the case of functional GI diseases originates from at least two conditions: frequency of diseases and bothersome symptoms with an impact on the quality of life (QoL). to make a correct diagnosis is therefore almost mandatory.