Gastrointestinal Neuromuscular Disorders
The Gastrointestinal Neuromuscular Disorders program was established in 2003 in order to provide a specialized clinical program for the diagnosis and treatment of patients with suspected or established disorders involving the nerves or muscles of the gastrointestinal tract. These disorders are typically difficult to diagnose and thus not evident by standard radiologic or endoscopic testing modalities. Examples of such disorders include achalasia, gastroesophageal reflux disease, gastroparesis, gastric dysrhythmias, colonic inertia, pelvic floor dyssynergia, and fecal incontinence.
Diagnostic modalities available include state-of-the-art equipment for esophageal manometry, prolonged ambulatory esophageal pH and impedance monitoring, electrogastrography (EGG), anorectal manometry, and breath hydrogen testing. The program performed over 1000 of these specialized studies in 2007.
The GI Neuromuscular Disorders program faculty is also committed to: (1) the education of our patients, fellows, residents, medical students, and community gastroenterologists through lectures, seminars, and other meetings, and (2) clinical research to better understand the pathophysiology of these disorders as well as to study new diagnostic and treatment modalities.
Dr. Kenneth L. Koch, MD
Professor of Medicine
Chief, Section on Gastroenterology
Director, Digestive Health Center
Medical School – University of Iowa, 1975
Residency – Milton Hershey Medical Center
Fellowship – University of Florida
Dr. Nyree K. Thorne, MD
Director, GI Neuromuscular Disorders Program
Assistant Professor of Medicine
Medical School – SUNY Upstate Syracuse, 2001
Residency – Winthrop-University Hospital
Fellowship – Winthrop-University Hospital
Dr. Carl Westcott, MD (General & laparoscopic surgery)
Dr. Adolfo Fernandez, MD (General & laparoscopic surgery)
Dr. Greg Waters, MD (Colorectal surgery)
Janet Fox, RN, GI Neuromuscular Disorders Procedure Unit
Lori Baydush, PT, Pelvic Floor & Biofeedback Therapy
Judy Hooker, BS, Research Coordinator
Symptoms - Nausea, vomiting, dyspepsia, heartburn
Disorders - Gastroparesis, gastric dysrhythmias, gastroesophageal reflux disease
Symptoms - Constipation, fecal incontinence, abdominal pain
Disorders – Pelvic floor dysfunction, fecal incontinence, irritable bowel syndrome
Evaluation of unexplained dysphagia
Evaluation of GERD refractory to medical therapy
Evaluation of unexplained nausea
Evaluation of gastroparesis refractory to medical therapy
Evaluation of refractory chronic constipation
Evaluation of fecal incontinence
GI Neuromuscular Disorders Procedure Unit
The GI Neuromuscular Disorders Procedure Unit is located in the Digestive Health Center but is physically separate from the Endoscopy Unit and Outpatient Clinic. The unit is one of the busiest in the Southeast performing over 1,000 procedures in 2007.
Esophageal manometry and impedance (Esophageal function testing)
- This procedure uses a small transnasal catheter to provide a measurement of the resting pressure and relaxation of the lower esophageal sphincter and assessment of peristalsis of the esophageal body. The addition of impedance monitoring provides an assessment of bolus transit.
- Common indications for esophageal function testing include unexplained dysphagia, suspected achalasia, gastroesophageal reflux disease, and preoperative assessment prior to antireflux surgery.
- In 2007, 283 esophageal manometries were performed in the GI Neuromuscular Disorders Procedures Unit.
Ambulatory 24-hour esophageal pH and impedance monitoring
- This procedure uses a small, flexible transnasal catheter that is positioned in the esophagus and allows prolonged measurement of the amount of acid that refluxes from the stomach into the esophagus during a 24-hour period. The addition of impedance monitoring allows detection of non-acid reflux and thus patients can be studied while taking proton pump inhibitor therapy.
- Common indications for 24-hour pH and impedance monitoring include heartburn or regurgitation refractory to medical therapy, atypical symptoms of gastroesophageal reflux disease, noncardiac chest pain, and preoperative assessment prior to antireflux surgery.
- In 2007, 321 ambulatory pH/impedance studies were performed in the GI Neuromuscular Disorders Procedures Unit.
- This procedure uses a small transanal catheter that is inserted into the anus and positioned in the rectum. This provides a measurement of the resting and squeeze pressures and relaxation of the anal sphincter, and an assessment of rectal sensation and pelvic floor relaxation.
- Common indications for anorectal manometry include chronic constipation, fecal incontinence, and rectal pain syndromes.
- In 2007, 187 anorectal manometry studies were performed in the GI Neuromuscular Disorders Procedures Unit.
- This procedure uses electrodes attached to the abdominal wall that measure the electrical rhythms of the stomach. These measurements, called electrogastrograms (EGGs), are similar to EKGs for the heart and EEGs for the brain.
- Common indications for electrogastrography include unexplained nausea and/or vomiting, gastroparesis, and functional dyspepsia.
- In 2007, 206 electrogastrography studies were performed in the GI Neuromuscular Disorders Procedures Unit.
Hydrogen breath testing
- The patient is given a set amount of a test sugar (eg. lactose, fructose, or sucrose), and at set time points over 2-3 hours, a device is used to collect expelled breath to measure levels of hydrogen.
- Common indications for hydrogen breath testing include testing for lactose or fructose intolerance and small intestinal bacterial overgrowth.
- In 2007, 200 hydrogen breath tests were performed in the GI Neuromuscular Disorders Procedures Unit.