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Gut 1999;45(Suppl 2):II17-II24 ( September )

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


© 1999 by Gut



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