The Motility Consultation

The study of gastrointestinal motility and those disorders that result from its disordered function has, for far too long, been a much neglected component of every gastroenterology curriculum. Clinicians are “put off” by discussions of motility that, in their view, appear to focus on details of gut electrophysiology, neurotransmitter function, and enteric neural morphology, while, in “real life,” disorders apparently resulting from pathology or dysfunction of enteric nerve and muscle and/or of the factors that control them go ignored. This neglect has been unfortunate given rapid progress in our understanding of the molecular and morphological basis of motor activity and of the physiology and basic pharmacology of motility, the advent of new approaches to the clinical assessment of disordered function, and an ever-increasing appreciation of the true frequency and clinical importance of dysmotility, be it in relation to a primary disorder of muscle or nerve, in the patient with cancer, in the context of a systemic or neurological disorder, or a consequence of a variety of therapeutic interventions. The clinician’s despair when confronted by a “motility problem” has not been helped by a very poor record in translating progress in the laboratory into useful therapies at the bedside.

This issue of Gastroenterology Clinics of North America attempts to redress this deficit by taking a very different approach to gastrointestinal motility and viewing it primarily from a clinical, rather than physiological or pathophysiological, perspective. Individual articles are framed, therefore, in a clinical context: the intensive care unit, the patient with neurological disease, the postoperative patient, for example. The clinical usefulness of new technologies is illustrated by the impact of high-resolution manometry on the classification of esophageal motor disorders and of various imaging modalities on the assessment of difficult defecation. To bridge the gap between bench and bedside, progress in our understanding of the basic pathology of motility disorders is emphasized in the opening article and the clinical relevance of these classifications developed further by Greger Lindberg.

Some therapeutic optimism is also provided by a critical review of the indications for and optimal mode of delivery of nutritional support and new therapeutic approaches dealt with in each of the clinical scenario articles. We hope that this issue will help the clinician to recognize dysmotility in contexts where he or she would not previously had considered its role, optimally assess the issue, and develop a therapeutic strategy that will be of most benefit to the patient.

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