Principles of applied neurogastroenterology: physiology/motility-sensation
J E Kellowa, M Delvauxb, F Azpirozc, M Camillerid, E M M Quigleye, D G Thompsonf
a Chair, Committee on
Physiology: Motility/Sensation, Multinational Working Teams to Develop
Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome
II), Departments of Medicine and
Gastroenterology, Royal North Shore Hospital,
University of Sydney,
Sydney, Australia, b Co-Chair, Committee on Physiology:
Motility/Sensation, Multinational Working Teams to Develop Diagnostic
Criteria for Functional Gastrointestinal Disorders (Rome II), Gastroenterology
Unit, University Hospital Rangueil,
Toulouse, France, c Department of Surgery,
Hospital General Vall d'Hebron,
Barcelona, Spain, d Gastroenterology Unit,
Mayo Clinic, Rochester,
Minnesota, USA, e Department of
Medicine, Cork University Hospital,
National University of Ireland,
Cork, Ireland, and University
of Nebraska Medical Center, Omaha, Nebraska,
USA, f Department of
Medicine, Hope Hospital,
University of Manchester,
Manchester, UK
Correspondence to: John E Kellow, MD, Associate Professor of Medicine, University of Sydney, Royal North Shore Hospital, St Leonards NSW 2065, Australia. Email: johnk{at}med.usyd.edu.au
Many of the symptoms characteristic of the functional
gastrointestinal disorders (FGID) are consistent with dysfunction of the motor and/or sensory apparatus of the digestive tract. Those aspects of sensorimotor dysfunction most relevant to the FGID include
alterations in: gut contractile activity; myoelectrical activity; tone
and compliance; and transit, as well as an enhanced sensitivity to
distension, in each region of the gastrointestinal tract. Assessment of
these phenomena involves a number of techniques, some well established
and others requiring further validation. Using such techniques,
researchers have reported a wide range of alterations in sensory and in
motor function in the FGID. Importantly, however, relationships between
such dysfunction and symptoms have been relatively weak, and so the
clinical relevance of the former remains unclear. Moreover, the
proportions of patients in the various symptom subgroups who display
dysfunction, and the extent and severity of their symptoms, require
better characterization. On a positive note, progress is occurring on
several fronts, especially in relation to functional dyspepsia and
irritable bowel syndrome, and based on the data gathered to date, a
number of areas where further advances are required can be highlighted.
Keywords: motility; sensation; gastrointestinal tract; functional gut disorders; functional dyspepsia; irritable bowel syndrome; visceral hyperalgesia; Rome II
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