Gastroenterology and Hepatology in Minnesota

Motility Interest Group

The Motility Interest Group consists of physicians who have special training and interests in disorders of gastrointestinal motility. The major disorders that fall into this category of gastrointestinal conditions include:

• Gastroparesis (slow gastric emptying) that can be associated with symptoms of gastroesophageal reflux, nausea, vomiting and anorexia
• Pseudo-obstruction (disorders of gastric and intestinal motility) that can be associated with all of the above in addition to distension, bloating, abdominal pain, undernutrition, weight loss and constipation
• Intractable constipation due either to slow transit or disorders of evacuation
• Functional bowel disorders, the irritable bowel syndrome (IBS), functional or non-ulcer dyspepsia (NUD)
• Undiagnosed diarrheal syndromes
• Fecal incontinence

Though some of these conditions do not have a well-defined pathophysiology or specific therapies, patients can often be helped by the highly focused therapeutic approaches that have been evaluated critically by the Mayo group.

Diagnostic resources available at Mayo Clinic in Rochester

Gastrointestinal transit
Using noninvasive methods, it is possible to measure by scintigraphy (or radiopaque marker techniques) the rate at which material leaves the stomach, moves through the intestines, and is evacuated from the rectum. These simple tests give an overview of the functions of the entire gastrointestinal tract.

Manometric studies of the esophagus, stomach and small intestine
Flexible catheters can be positioned at different levels of the upper gut. By recording the contractions of the intestinal muscle, the strength and coordination of the muscle can be characterized.

Manometric studies of the colon
Can identify muscle strength and coordination in the colon. These approaches are particularly applicable to patients with severe constipation.

Anorectal manometry, balloon expulsion
The strength and coordination of the final step of rectal evacuation can be quantified. Complementing these approaches are:

• Studies of pelvic floor function, muscle coordination, neural innervation
• Electromyography of pelvic floor muscles and anal sphincters
• Mobility of the pelvic floor during defecation:
  • Scintigraphic quantification of evacuation
  • Defecating proctography
• Innervation of the pelvic floor/sphincters — Pudendal nerve terminal motor latency

Assessments of autonomic innervation/denervation
Together with Mayo's Autonomic Function Laboratory, tests of cardiac and sudomotor (sweating) function are used to assess the competency of autonomic innervation of the gut.

Diagnostic pathology
Histologic samples can be assessed for patterns of innervation (or denervation) by the intrinsic nervous system of the gut.

Behavioral and psychosocial factors
Recognizing that some of the disorders described above often have important contributions from stress and other psychosocial factors, the Mayo Motility Interest Group has developed close ties for evaluation and therapy with:

• Behavioral Medicine: Donald Williams, Ph.D., consults daily on selected patients.
• Physical Medicine and Rehabilitation for detailed and extensive programs of biofeedback (constipation, fecal incontinence).
• A daily Irritable Bowel Syndrome Class (supervised by the Motility Interest Group) taught by a nurse who has special training in the area with input from registered dietitians, behavioral psychologists and physical therapists.

Chronic pain program
A multidisciplinary team of behavioral psychologists, anesthesiologists and psychotherapists which consults on major problems of chronic abdominal pain and coordinates rehabilitation.

Colorectal surgery
The Motility Interest Group interacts surgeons from Colorectal Surgery who have special interest in intractable constipation and fecal incontinence.