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Advanced Training in GI Neuromuscular Disorders


The Section of Gastroenterology at Wake Forest Baptist Medical Center is pleased to offer a one-year program for advanced training in gastrointestinal neuromuscular disorders.  Adequate training in all aspects of GI neuromuscular disorders (NMD) is rarely achieved in most three-year GI fellowship programs.  This requires an in-depth understanding of the pathophysiology, clinical presentation, diagnosis, and therapy of these disorders.  Training in motility testing is challenging and requires intensive exposure to esophageal, gastric, and colorectal testing using radiologic and manometric techniques.  The goal of the advanced training program in GI neuromuscular disorders at WFBMC is to train fellows to become experts in this exciting subspecialty in gastroenterology who will provide exceptional patient care and continue the educational and investigative work required to move this dynamic field forward.

Program Structure

The advanced training program in GI neuromuscular disorders at WFBMC is a one-year program.  The trainee will spend at minimum 4 months dedicated to intensive clinical exposure in GI neuromuscular disorders which will include:

  • Outpatient consultation clinics with GI NMD faculty focused on patients with a wide range of challenging GI neuromuscular disorders
  • Ongoing performance, review and interpretation of diagnostic studies to include esophageal and anorectal manometry, ambulatory 24-hour esophageal pH/impedance monitoring, electrogastrography, and hydrogen breath testing

The trainee will spend at least 4 months on dedicated research during which time clinical activities will be limited to include only outpatient clinic and rotation in the GI NMD procedures unit.  The remaining 4 months will be dedicated to general GI service.  General GI service activities include coverage of the inpatient GI Consult service (max. 4 weeks), outpatient general endoscopy, participating in the attending call rotation, and if needed supervision of GI fellows in clinic.  Advanced trainees are typically appointed to junior faculty positions at the Instructor level.

Faculty Clinical Experience

Trainees will work under the guidance and supervision of two full-time faculty members who specialize in GI neuromuscular disorders.  These include:

  • Kenneth L. Koch, MD, Professor of Medicine and Chief, Section of Gastroenterology.  Dr. Koch joined the faculty in 2003 and specializes in neuromuscular disorders of the stomach such as gastroparesis and unexplained nausea and vomiting.  He is an expert on electrogastrography.
  •  Nyree Thorne, MD, Assistant Professor of Medicine and Director, GI Neuromuscular Disorders Center.  Dr. Thorne joined the faculty in 2007 and specializes in neuromuscular disorders of the colon and rectum such as constipation, pelvic floor dysfunction, fecal incontinence and irritable bowel syndrome.  She has expertise in anorectal manometry and other colorectal motility techniques.


The GI Neuromuscular Disorders program at WFBMC is one of the busiest in the Southeast.  Over 1200 diagnostic procedures were performed in the GI NMD procedures unit in 2009.  Fellows will be trained to proficiency in all aspects of GI NMD diagnostic testing to include esophageal manometry, ambulatory pH/impedance monitoring, anorectal manometry, electrogastrography, and hydrogen breath testing.  Additional experience may be obtained with emerging diagnostic techniques such as the SmartPill system.  Antroduodenal and colonic manometry are also performed, primarily by our colleagues in pediatric gastroenterology.  Finally, exposure to interpretation of radiologic and nuclear studies used for investigating GI NM disorders will also be provided. 


Trainees will spend 2 or 3 half-days per week in the outpatient consultative clinics of the faculty which focus on patients referred with GI neuromuscular disorders.  Trainees will have opportunities to participate in specialized therapies for GI neuromuscular disorders such as pneumatic dilation and Botox injection for achalasia and gastric electrical stimulation for gastroparesis.  


Trainees will participate in clinical and research conferences held by the GI section every Tuesday and Thursday afternoon.  These include GI Grand Rounds, GI Journal Club, and interdisciplinary conferences with colleagues in Radiology, Pathology, and Surgery.  In addition, trainees will participate in our GI NMD Research meeting held every Tuesday and also present 1-2 interesting or challenging cases at the GI NMD Clinical Conference held monthly.

Research Experience

Trainees will be expected to initiate at least one clinical research project during their year of training.  As part of the GI NMD team, trainees will be expected to actively participate in ongoing prospective original and industry-sponsored clinical trials as well as complete at least one retrospective study.  Trainees will be supported to present their research at national meetings such as the Digestive Disease Week (AGA), ACG, and ANMS.  In addition, trainees will be expected to write at least one book chapter, review article, or case series.

*For more information about this program, please contact Dr. Thorne at the Email or office address listed below.


Applicants should be current second or third-year GI fellows or have recently completed a GI fellowship.  Successful applicants will have experience in clinical research and demonstrate a strong interest in a career in academic gastroenterology.  Applications will be accepted between 24 and 12 months prior to starting the program.  This is not a J-1 visa opportunity.  Please submit a cover letter, recent CV, and two letters of recommendation to:

Nyree Thorne, MD
Assistant Professor of Medicine
Director, GI Neuromuscular Disorders Program
Section of Gastroenterology
Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC 27157
Email address:
Phone #:  336-713-7311


Quick Reference

Gastroenterology Fellowship Program Director


Joel Bruggen, MD
Wake Forest Baptist Medical Center
Medical Center Boulevard
Winston-Salem, NC  27157
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