Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

This multi-authored book covers most aspects of evaluation of gastrointestinal motility – a field that has been expanding in recent times largely due to advances in diagnostic modalities; coupled with this, new evidences supporting best practices have increased the interest among clinical gastroenterologists, researchers, teachers and trainees in gastrointestinal motility and its disorders. New advances in the field of evaluation of functional bowel diseases and motility disorders, such as high-resolution manometry, 24-h pH impedance monitoring, Bravo capsule pH-metry, barostat, balloon expulsion test, barium and MR defecography, biofeedback, hydrogen breath tests, motility capsule (smartpill) etc. have significantly expanded the scope and outcome of treating these disorders. The chapters have been contributed by a well-conversant group of experts from the global academia, including India, Singapore, Thailand, Korea and Australia, integrating the body of knowledge on evaluation methods with evidence of best practices for the management of motility disorders. A chapter on how to set-up a manometry laboratory provides key information for clinicians and researchers who are planning to start working in this area. With 11 chapters in the book supported with numerous tables, flow charts, schematic diagrams and images, professionals will find it an essential reading. ​

​This book describes the causes and clinical management of functional gastrointestinal disorders in a readily understandable way, with the aid of many clear illustrations. The concrete and practical advice provided will be most helpful in the clinical practice of both the general practitioner and the medical specialist. Functional disorders of the gastrointestinal tract, such as gastroesophageal reflux disease, functional dyspepsia, and irritable bowel syndrome, are very common and chronic conditions. Despite the recent publication of many scientific papers on their diagnosis and treatment, much remains unclear, and management is still considered challenging. This practice-oriented book will be an ideal source of reliable up-to-date guidance for all who care for these patients.

This issue of Gastroenterology Clinics of North America is on Gastrointestinal Motility Disorders. GI motility disorders are common reasons for patients to see gastroenterologists. Knowledge of the pathophysiology, evaluation and treatment of these disorders is important to appropriately care for patients with gastrointestinal motility disorders in clinical practice. The chapters of this issue will discuss key aspects of gastrointestinal motility disorders focusing on how they relate to practicing gastroenterologists and other health care providers. Current knowledge in the area as well as evolving concepts from clinical investigations and translational research from basic sciences will be discussed. The rapid explosion of new technology used in the evaluation of patients will be covered.

This guide focuses on the answers to patient questions that are frequently posed to providers who care for patients with GI motility disorders. Additionally, the text guides clinicians through the complicated diagnostic and therapeutic/management approaches to motility disorders, including common and specialized tests, drug initiation, medications side effects, and disease complications. Written by experts in the field, Gastrointestinal Motility Disorders: A Point of Care Clinical Guide is a valuable reference for busy clinicians who need the best evidence-based answers to patient questions at their fingertips.

Clinical and Basic Neurogastroenterology and Motility is a state-of-the-art, lucidly written, generously illustrated, landmark publication that comprehensively addresses the underlying mechanisms and management of common adult and pediatric motility disorders. These problems affect 50% of the population and include conditions such as dysphagia, achalasia, gastroesophageal reflux disease, gastroparesis, irritable bowel syndrome (IBS), gas and bloating, SIBO, constipation and fecal incontinence. The book brings together international experts and clinician scientists, epitomizing their years of wisdom into a concise yet practical text that is delivered in two distinct sections, basic and clinical. It fulfills a large unmet need, and bridges a long-awaited knowledge gap among trainees, clinicians, scientists, nurses and technicians, earnestly engaged in this field. - First of its kind text that covers both basic and clinical aspects, bridging the knowledge gap, and providing a bench to bedside approach for management of common disorders - Discusses the latest concepts and basic principles of neurogastroenterology and motility, and how the gut and brain interact in the genesis of functional gastrointestinal and motility disorders - Provides an illustrated and practical text on hot topics written by leading adult and pediatric gastroenterology experts across the globe - Includes an accompanying more detailed web version of the text with free access to future podcasts

This volume provides a comprehensive and up-to-date theoretical review and practical guide on pediatric gastrointestinal motility and functional disorders. The latest edition includes extensively revised and new chapters to reflect the rapidly growing field of pediatric neurogastroenterology. New topics covered include neurobiology of pain in children, functional oropharyngoesophageal assessment, dysautonomia, and psychotropic drugs. The text also features instructive illustrations, photographs, and tables. Written by world-renown experts in the field, Pediatric Neurogastroenterology: Gastrointestinal Motility and Functional Disorders in Children, Second Edition is a valuable resource for pediatric gastroenterologists, adult gastroenterologists, pediatricians, and all professionals involved in the treatment and management of children with such disorders.

Clinical Small Animal Internal Medicine is a comprehensive, practical reference designed to meet the needs of veterinary practitioners and students alike. Covering all aspects of small animal internal medicine, this innovative guide provides clinically relevant material, plus podcasts and continual updates online. Concise, identically-formatted chapters allow readers to quickly find the most essential information for clinical veterinary practice. Contributions from academic and clinical experts cover general medicine subjects, including patient evaluation and management, critical care medicine, preventative care, and diagnostic and therapeutic considerations. Topics relevant to daily clinical practice are examined in detail, ranging from endocrine, cardiovascular, respiratory, and infectious disease to oncology, dermatology, metabolic orthopedic disease, gastroenterology, and hepatology. A companion website features podcasts and updated information. An important addition to the library of any practice, this clinically-oriented text: Presents complete, practical information on small animal internal medicine Provides the background physiology required to understand normal versus abnormal in real-world clinical settings Includes general medicine topics not covered in other internal medicine books Focuses on information that is directly applicable to daily practice Features podcasts and continual updates on a companion website Carefully tailored for the needs of small animal practitioners and veterinary students, Clinical Small Animal Internal Medicine is an invaluable, reader-friendly reference on internal medicine of the dog and cat.

This book explains the pharmacological relationships between the various systems in the human body. It offers a comprehensive overview of the pharmacology concerning the autonomic, central, and peripheral nervous systems. Presenting up-to-date information on chemical mediators and their significance, it highlights the therapeutic aspects of several diseases affecting the cardiovascular, renal, respiratory, gastrointestinal, endocrinal, and hematopoietic systems. The book also includes drug therapy for microbial and neoplastic diseases. It also comprises sections on immunopharmacology, dermatological, and ocular pharmacology providing valuable insights into these emerging and recent topics. Covering the diverse groups of drugs acting on different systems, the book reviews their actions, clinical uses, adverse effects, interactions, and subcellular mechanisms of action. It is divided into 11 parts, subdivided into several chapters that evaluate the basic pharmacological principles that govern the different types of body systems. This book is intended for academicians, researchers, and clinicians in industry and academic institutions in pharmaceutical, pharmacological sciences, pharmacy, medical sciences, physiology, neurosciences, biochemistry, molecular biology and other allied health sciences.

Parkinson’s Disease and Nonmotor Dysfunction fills a major gap in the current rapidly growing body of knowledge concerning Parkinson’s disease. Drs. Pfeiffer and Bodis-Wollner have correctly perceived that many nonmotor features of Parkinson’s disease are given insufficient attention in the medical literature. Unfortunately, they are often also given insufficient attention by the practicing neurologists who see these patients. As recently pointed out, there is clearly much more to Parkinson’s disease than depletion of the nigrostriatal dopamine system (1). Parkinson’s disease (not just m- tiple system atrophy) is a multisystem disorder, both pathologically and in its clinical manifestations. This is clearly true for the various motor system abnormalities, which are not fully corrected by dopamine replacement therapy strategies, but also for the nonmotor system abnormalities that are the subject of this volume. Although recently there has been increased awareness of the cognitive, psychiatric, and sleep disorders commonly associated with Parkinson’s disease, many of their manifestations remain under-recognized and their importance in managing patients is underestimated. Even less attention is paid to the myriad of other nonmotor disturbances that plague these patients. For example, among the autonomic disorders, although orthostatic hypotension is well recognized, it is usually attributed to dopaminergic medications rather than to effects of the underlying disease. Urologic disorders are also very familiar in these patients, but may not be properly understood or well managed.