Disorders of gastrointestinal motility: Towards a new classification<b><sup>1</sup></b>

Wingate, David; Hongo, Michio; Kellow, John; Lindberg, Greger; Smout, A. J. P. M.

doi:10.1046/j.1440-1746.17.s1.7.x

Cited by 114 publications

(135 citation statements)

References 83 publications

(63 reference statements)

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“…This classification requires both symptoms of impaired motor activity and demonstrable abnormalities in motor function, for example manometric abnormalities with or without evidence of transient or persistent radiological visceral dilatation (Wingate et al 2002).…”

Section: Gastrointestinal Neuromuscular Diseasesmentioning

confidence: 99%

“…Primary GINMDs include oesophageal achalasia (Hertz 1915), gastroparesis (Shellito et al 1984), enteric dysmotility (ED) (Wingate et al 2002) and chronic idiopathic intestinal pseudo-obstruction (CIPO) (Dudley et al 1958) (for the purposes of this thesis ED and CIPO are referred to collectively as severe intestinal dysmotility: SID), slow-transit constipation (STC) (Preston et al 1986) and idiopathic megabowel (Bodian et al 1949)..…”

Section: Gastrointestinal Neuromuscular Diseasesmentioning

confidence: 99%

“…Some international consensus exists on the clinico-physiological diagnosis of such disorders (Wingate et al 2002). Histopathological changes in nerves (Schuffler et al 1982), smooth muscle ) and interstitial cells of Cajal (ICC) (Huizinga 1998;He et al 2000;Farrugia 2008) have been variably described in most and have received recent attention by an international working group (Knowles et al 2010).…”

Section: Gastrointestinal Neuromuscular Diseasesmentioning

confidence: 99%

“…Enteric dysmotility describes patients with demonstrably abnormal small bowel contractility, but no history of frankly obstructive episodes. These patients may be at an early stage in the progression of CIPO, or perhaps be those in a quiescent period of a relapsing / remitting pseudo-obstriction (Wingate et al 2002;). Whilst the pathophysiology of these disorders remains poorly understood, CIPO may be classified according to recognised histopathological abnormalities of enteric smooth muscle (myopathies), ENS (neuropathies) and of ICC (mesenchymopathies).…”

Section: Severe Intestinal Dysmotilitymentioning

confidence: 99%

“…The median number of years from presentation to donation of a blood sample for this study was 10 (range 3-40). Chronic idiopathic intestinal pseudoobstruction (CIPO) was diagnosed in 7 patients (5 female) on a basis of typical gastrointestinal symptoms (abdominal pain, severe constipation, abdominal distension, nausea and vomiting, weight loss; see Table 2.1), sub-occlusive events with radiological signs mimicking mechanical obstruction (air/fluid levels with or without dilatation on plain abdominal radiograph) and abnormal small bowel manometry (Dudley et al 1958;Wingate et al 2002) (Table 2.2). Twenty patients had abnormal intestinal motility but no history of sub-occlusive episodes and were classified as enteric dysmotility (Wingate et al 2002;).…”

Section: Severe Intestinal Dysmotilitymentioning

confidence: 99%

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The role of humoral autoimmunity in gastrointestinal neuromuscular diseases

Hubball

Martin

Lang

et al. 2009

Progress in Neurobiology

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Dysfunction of the gastrointestinal neuromuscular apparatus (including interstitial cells ofCajal) is presumed to underlie a heterogeneous group of disorders collectively termed gastrointestinal neuromuscular diseases (GINMDs). Humoral (antibody)-mediated autoimmunity directed against ligand-or voltage-gated ion channels or associated proteins involved in neuromuscular transmission is associated with several acquired neuromuscular diseases of the periphery and is now implicated in an increasing number of less well-characterised diseases. Anti-channel antibodies have been reported in small numbers of patients with GINMD, particularly in those with GI dysfunction secondary to an underlying disease such as neoplasia or infection. However, little is known of humoral autoimmunity in primary GINMDs.This thesis investigated the association between anti-channel antibodies and GINMD, and the human GI tract as a potential target of anti-channel antibodies. The presence of antivoltage-and ligand-gated antibodies was investigated in the serum of patients with primary achalasia, enteric dysmotility and intestinal pseudo-obstruction, and in those with GINMD secondary to Chagas' disease. The functional effect of sera from some of these patients on colonic smooth muscle contractility was also characterised. Finally, the distribution of six voltage-gated potassium channels (VGKCs), which serve essential roles in the peripheral and central nervous systems and are known targets of pathological autoantibodies, were investigated in all layers of the human GI tract.Our findings suggest that currently recognised anti-channel antibodies are not a common pathogenic factor in primary GINMDs. Anti-channel antibodies, in particular anti-VGKC antibodies, were however found in a significant number of individuals with Chagas' disease. Furthermore, circulating factors in patients with chagasic GI disease altered GI smooth muscle contractility in vitro which may have pathological relevance to GI

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Section: Gastrointestinal Neuromuscular Diseasesmentioning

confidence: 99%

Section: Gastrointestinal Neuromuscular Diseasesmentioning

confidence: 99%

Section: Gastrointestinal Neuromuscular Diseasesmentioning

confidence: 99%

Section: Severe Intestinal Dysmotilitymentioning

confidence: 99%

Section: Severe Intestinal Dysmotilitymentioning

confidence: 99%

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The role of humoral autoimmunity in gastrointestinal neuromuscular diseases

Hubball

Martin

Lang

et al. 2009

Progress in Neurobiology

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Megacolon and Pseudo‐Obstruction

Quigley

2012

Textbook of Clinical Gastroenterology and Hepatology

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Intestinal Obstruction and Pseudo‐obstruction

Prather

2010

Practical Gastroenterology and Hepatology: Small and Large Intestine and Pancreas

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Identifying the etiology of abdominal pain, nausea, and vomiting often remains a challenge for clinicians. A laundry list of etiologies exists for these symptoms including acute gastroenteritis, peptic ulcer disease, metabolic etiologies, medication effects, gastroparesis, mechanical obstruction, and pseudo -obstruction. This review focuses on the diagnosis and management of intestinal mechanical obstruction, intestinal pseudoobstruction, and differentiating the two. Early identifi cation of complete mechanical obstruction and/or the presence of intestinal ischemia or peritonitis is paramount, as these patients benefi t from early surgical intervention. Most patients with partial bowel obstruction may be managed medically. Clinical recognition of intestinal pseudo -obstruction avoids unnecessary surgery and directs treatment towards symptomatic management. The role of newer imaging techniques, CT and MR radiography and other, newer diagnostic techniques in intestinal pseudo -obstruction is also reviewed. mechanical obstruction is partial (incomplete). Acute intestinal mechanical obstruction may be subdivided into three broad categories with the obstruction the result of: (i) abnormalities of the bowel wall; (ii) extrinsic compression; or (iii) intraluminal process. Abnormalities of the bowel wall include infl ammatory or fi brotic strictures as in Crohn disease. The most common extrinsic etiology remains fi brous adhesions. Hernias would also fall in this category. Intraluminal causes of bowel obstruction include ingested foreign bodies, gall stones, parasites, and tumors. Adhesions, the most common cause of bowel obstruction, occur commonly following abdominal surgery. Adhesions develop in up to 93% of individuals with prior intra -abdominal surgery versus a prevalence of only 10% in patients without prior abdominal surgery [1] . Acute intestinal mechanical obstruction must further be subdivided into simple obstruction, without vascular compromise, versus obstruction complicated by vascular comprise and/or peritonitis, the latter requiring urgent surgical intervention.The medical management of complete bowel obstruction remains relatively straight forward with management responsibilities most often falling to the surgeon. 290 CaseA 65 -year -old, long -time smoker presents to the Emergency Department with a 2 -day history of worsening abdominal pain, distension, diarrhea, nausea, and vomiting. This is her third visit in the past several months, and she has been hospitalized each time for conservative treatment. She has responded each time to nasogastric suction and intravenous fl uids. CT imaging reveals diffusely dilated loops of small bowel without evidence of a transition point or mass lesion. The dilation is noted to be worse than on previous fi lms. She again responds symptomatically with decompression and bowel rest, but is noted to have a 4.5 kg (10 lb) weight loss since her last admission.

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Disorders of gastrointestinal motility: Towards a new classification¹

Cited by 114 publications

References 83 publications

The role of humoral autoimmunity in gastrointestinal neuromuscular diseases

The role of humoral autoimmunity in gastrointestinal neuromuscular diseases

Megacolon and Pseudo‐Obstruction

Intestinal Obstruction and Pseudo‐obstruction

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Disorders of gastrointestinal motility: Towards a new classification1

Cited by 114 publications

References 83 publications

The role of humoral autoimmunity in gastrointestinal neuromuscular diseases

The role of humoral autoimmunity in gastrointestinal neuromuscular diseases

Megacolon and Pseudo‐Obstruction

Intestinal Obstruction and Pseudo‐obstruction

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Product

Resources

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Disorders of gastrointestinal motility: Towards a new classification¹