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This third edition brings together the latest in research and clinical practice of the expanding field of pediatric neurogastroenterology. In addition to a comprehensive review of the current state of the art, many chapters have been significant revised and updated, covering the latest discoveries of the delicate and detailed mechanisms of the neuroenteric system as well as relationships of the latter with microbiota and metabolites produced by resident intestinal bacteria. The book also covers rapidly-changing techniques to assess clinical problems, along with international diagnostic criteria and recommendations and guidelines for clinical management. The content is supported by ample figures, photographs and selected video segments.Remaining the gold standard text in this up-and-coming field, Pediatric Neurogastroenterology 3e is dedicated to reporting the most accurate and recent knowledge available. Written by international experts in the field, the bookis a comprehensive and up-to-date theoretical review and practical guide to pediatric gastrointestinal motility and functional disorders to pediatricians, pediatric gastroenterologists and all professionals involved in the treatment of children with such disorders.

Regulatory Mechanisms in Gastrointestinal Function includes a collection of contemporary topics in gastrointestinal research. The control of gastroduodenal electrolyte transport and the influence of drugs on bicarbonate secretion are reviewed in detail. The importance of the interactions between calcium and cyclic-AMP in intestinal secretion is emphasized in a comprehensive chapter that systematically addresses each link in the mechanisms that regulate chloride secretion. Other important topics included in the book are neural reflex modulation of intestinal epithelial transport, the influence of the microcirculation on intestinal secretion, and nitric oxide as a mediator of physiologic and pathophysiologic secretion. The expertise of the authors has resulted in a breadth of important contemporary topics covered in depth.

​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 book provides readers with a succinct but comprehensive overview of current concepts relating to intestinal failure, including its treatment, with a particular focus on recent advancements. The opening chapters address basic aspects of intestinal failure, including etiology, clinical pathophysiology, physiology of intestinal adaptation, and intestinal microbiota. The complications of intestinal failure, such as bacterial overgrowth and intestinal failure-associated liver disease, are then discussed. A series of chapters specifically address important strategies in the nutritional, pharmacological, and surgical treatment of intestinal failure as well as the concept of intestinal rehabilitation. Finally, two significant emerging developments are considered: regenerative medicine and distraction enterogenesis. The authors are internationally recognized experts from Europe and North America who are ideally placed to describe current knowledge and progress in the field.

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. ​

The clinical problems and dilemmas which the busy clinician encounters on a daily basis are the main focus of this publication. Emphasizing a clinical rather than a pathophysiological approach to problems, it facilitates access and helps the practicing clinician to develop an effective and efficient diagnostic and therapeutic strategy. Nevertheless, clinically important aspects of pathophysiology are also dealt with in detail when called for. A variety of scenarios that are especially relevant to modern medical practice, such as the intensive care unit, are taken into account. A group of internationally renowned experts guides the reader through the broad variety of diagnostic options available to assist in the assessment of symptoms originating anywhere along the gastrointestinal tract, from the esophagus to the anus, and, in each instance, every effort is made to critically appraise the technology discussed. Moreover, general overviews of broadly relevant therapeutic approaches are also provided. Pediatric and adult gastroenterologists, gastrointestinal surgeons and hospitalists will find this publication to be a valuable help in their daily practice.

Neurogastroenterology is devoted to'study the interface of all aspects of the digestive system with the different branches of the nervous system'. Over the past 15 years advances in this field has greatly improved our understanding in primary functional and motility disorders in children. Neurogastroenterology has also begun to revolutionize our vision of'organic'diseases like inflammatory bowel disease, obesity, diabetes as well as microbial-host interactions. Major advances have also been achieved during these years in the knowledge of mechanisms of development of the enteric nervous system at the molecular level allowing a better understanding of diseases related to developmental anomalies and opening perspectives to new treatments with stem cells.Pediatric Neurogastroenterology: Gastrointestinal Motility and Functional Disorders in Children is dedicated to report the most accurate and recent knowledge in the field. Written by the world-renown experts, the book covers the field by providing a comprehensive and up-to-date review and practical guide to pediatric gastrointestinal motility and functional disorders for pediatricians, pediatric gastroenterologists, adult gastroenterologists and all professionals involved in the treatment of children with such disorders.

Research into gastrointestinal motility has received renewed interest in part due to recent advances in the techniques for measuring the structure and function of gastrointestinal cells, tissue and organs. The integration of this wealth of data into biophysically based computation models can aid in interpretation of experimental and clinical measurements and the refinement of measurement techniques.The contents of this book span multiple scales - from cell, tissue, organ, to whole body and is divided into four broad sections covering: i) gastrointestinal cellular activity and tissue structure; (ii) techniques for measuring, analyzing and visualizing high-resolution extra-cellular recordings; (iii) methods for sensing gastroelectrical activity using non-invasive bio-electro-magnetic fields and for modulating the underlying gastric electrical activity and finally (iv) methods for assessing manometric and videographic motility patterns and the application of these data for predicting the flow and mixing behavior of luminal contents by using computational fluid dynamic techniques. This book aims to provide both an overview of historical and existing research techniques as well as to highlight future directions and challenges for the community as a whole. It will be suitable for clinicians to understand the cellular and biophysical underpinnings of gastric emptying, gastroenterologists, surgeons, bioengineers and all scientists with interests in gastrointestinal motility research.

The basis of this book is a ten-lecture course on the control of gastrointesti­ nal motility given each year to the final year undergraduate students in Physiology at Sheffield University. A naive thought led me to believe that the conversion of my lecture notes into the present book would be a relatively easy task. I now know differently. As there is no equivalent undergraduate course elsewhere that I know of, it would be dishonest of me to claim this book to be an undergraduate text. The comprehensive way in which I have dealt with the subject, together with the inclusion of the most up-to-date material, make the book more relevant to postgraduate students of physiology, medicine and related sciences who require an introduction to the field of gastrointestinal motility and its control. I have, however, attempted to present the current concepts on the physiological mechanisms regulating motility in a way which under­ graduates, as well as postgraduates, will find readable, informative and, hopefully, enjoyable.

Los trastornos funcionales digestivos, entre ellos el síndrome de intestino irritable, constituyen la primera causa de consulta al gastroenterólogo y una de las primeras al médico general. De hecho, en conjunto con los trastornos de la motilidad, forman parte de una de las áreas más jóvenes de la gastroenterología moderna y con mayor crecimiento e investigación en los últimos años. Debido a que los trastornos funcionales y las alteraciones de la motilidad dependen principalmente de una alteración del eje cerebro-intestino, han dado lugar incluso a la creación de una nueva especialidad, conocida como neurogastroenterología. No es sorprendente, entonces, que en esta idea de editar las Clínicas de Gastroenterología de México por parte del Presidente de la Asociación Mexicana de Gastroenterología, Dr. Juan Miguel Abdo Francis, el segundo número de dichas Clínicas sea dedicada precisamente a estos problemas. Hemos revisado los trastornos funcionales y motores del tubo digestivo más frecuentes con los cuales nos enfrentamos los gastroenterólogos de México en nuestra práctica diaria, así como los métodos diagnósticos y terapéuticos relacionados, con la característica de plasmar en cada uno de los capítulos la experiencia personal y publicada en nuestro país.

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.

Los trastornos de la motilidad gastrointestinal han cobrado gran importancia debido a un mayor conocimiento de los mismos y a las nuevas clasificaciones que estableció la reunión de consenso de Roma llevada a cabo en 1999, conocida como Criterios de Roma. Los Criterios de Roma III se establecieron en el año 2006. Los trastornos motores de dicho grupo afectan la calidad de vida de los pacientes, pueden dañar cualquier segmento del aparato digestivo y se caracterizan por ser funcionales y de difícil manejo, lo cual origina situaciones complicadas en la relación médico–paciente. El concepto de tubo digestivo ha sido ampliamente superado a la luz del conocimiento de un'cerebro intestinal'. Es un complejo sistema neuroendocrino que posee neuronas aferentes y eferentes, neurotransmisores presinápticos y postsinápticos, y excitadores e inhibidores de acción rápida o lenta que condicionan estas respuestas. El mediador bioquímico más importante implicado en la fisiopatología de la dismotilidad es la serotonina, que se localiza en 95% en el aparato digestivo. También es muy importante la acción colinérgica en la fisiopatología, porque favorece la irritabilidad del mecanismo neuromuscular del intestino. El impacto en la calidad de vida y su alta prevalencia en poblaciones económicamente activas con una repercusión económica importante le han conferido un interés particular a este grupo de padecimientos. Varios estudios han documentado el impacto del síndrome de intestino irritable (SII), por ejemplo, en la calidad de vida y el desempeño laboral. En México los doctores Schmulson y Valdovinos han informado en la Revista de Gastroenterología de México acerca de esta relación, con una disminución en la calidad de vida y en el rendimiento laboral de los pacientes. Los estudios de Hungin y col. han documentado también la repercusión económica de estas patologías, situación que ha sido estudiada mediante el ausentismo laboral en Brasil y EUA con la observación de que los trastornos motores producen un mayor ausentismo laboral al compararlo con los grupos controles (de 1.5 a 5% vs. de 4 a 10% en SII). En este estudio los autores informan que 36% de los pacientes con SII de EUA y de 10 a 29% de los pacientes de los países europeos han perdido su trabajo en el último año por ausentismos debidos a dichos síntomas. Es muy conveniente recordar que cerca de un tercio de las consultas del especialista se deben a trastornos funcionales digestivos y que el número de visitas promedio por paciente es de dos a tres por año.

While reflux disease, achalasia, esophageal spasm, gastroparesis and IBS include some of the most common disorders in all disease categories, the understanding of their pathophysiology has remained elusive. The field of clinical gastrointestinal motility has for decades relied on the measurement of intestinal movements for diagnosis and management of these difficult and enigmatic disorders of gut function. Although computers have increased the speed with which we can measure the movements of the gut, the devices to measure this movement have not changed in over 20 years. In the last 2 years, a new technologic breakthrough has taken place in the measurement of intestinal movement. The technology is called high resolution manometry. Rather than the old 4 and 8 channels systems of measuring pressure, high resolution employs 36 closely spaced solid state pressure transducers. By using this technology, the resolution of gut motor activity is incredible. This allows for better ways of viewing motility using color as pressure. This technology makes for beautiful images of gut motility that we have never seen before. We have made diagnoses that would never have been appreciated with the old technology. High resolution manometry is taking over conventional manometry worldwide and represents a dramatic leap in a long time stagnant area.

Gastrointestinal function represents an important, and hitherto inappropriately neglected, aspect of diabetes management. Disordered gastrointestinal motor and sensory function occurs frequently in both type 1 and type 2 diabetes and may be associated with gastrointestinal symptoms that adversely affect quality of life. During the last two decades there has been a rapid expansion in knowledge in this area. It is now recognised that upper gastrointestinal motility is pivotal to the regulation of postprandial blood glucose concentrations in both health and patients with diabetes. This book is the first of its kind and was stimulated by the need to consolidate these recent advances, which dictate that a knowledge of gastroenterology as it relates to diabetes is now required of the clinician/diabetologist. • Features an organ-specific overview of the epidemiology and pathophysiology of disordered gastrointestinal (including hepatobiliary and pancreatic) function in diabetes mellitus • Contains guidelines for the clinician, diabetologist and gastroenterologist for both diagnosis and management • Includes a comprehensive description of the relation between gastrointestinal function, gastrointestinal hormones, autonomic nerve function and glycaemic control in animal models • Covers the development of new treatment options, particularly those targeted at the reduction of postprandial hyperglycaemia, to optimise glycaemic control This book will be of interest to gastroenterologists, diabetologists, specialist nurses and clinical researchers.

The Handbook of Electrogastrography is the first textbook dedicated to reviewing the physiology of gastric myelectrical activity and the measurement of this electrical activity with electrodes placed on the abdominal surface - the electrogastrogram. The Handbook is divided into three major sections. The first section (Chapters 1-3) focuses on the history of electrogastrography, electrical activity of the interstitial cells of Cajal, the cells from which gastric electrical rhythmicity emanates. The cellular level of gastric electrical rhythmicity provides an understanding of the physiological basis of the electrogastrogram signal. The second major section of the book (Chapters 4-6) incorporates the practical aspects of recording a high quality electrogastrogram and approaches to the analysis of the electrogastrogram using visual inspection and computer techniques. This section focuses on the authors'combined experience of examining EGG recordings for more than sixty years. From this rich research and clinical experience, the clinical application of EGG recordings in an approach to patients with unexplained nausea and vomiting is described. Neuromuscular disorders of the stomach involving gastric dysrhythmias are reviewed. The third major section of the book (Chapters 7-9) comprises many examples of gastric dysrythmias ranging from bradygastrias to tachygastrias and mixed dysrythmias. Current understanding of the mechanisms of gastric dysrhythmias is reviewed. Artifacts in the EGG signal, which may be confused with gastric dysrhythmias, are also presented. The Handbook of Electrogastrography will be a valuable reference for physicians interested in recording gastric electrical activity in clinical practices or in clinical research. Gastroenterologists, internists, psychologists and others with an interest in gastric myoelectrical events will also find extensive and relevant information for recording and interpreting EGGs in the Handbook.

This book provides the first comprehensive review of research that addresses the immunomodulation of gastrointestinal motility. Results from this new field of research are important for understanding motility disturbances and symptom-generation in a variety of clinical gastroenterological problems, including ulcerative colitis, Crohn's disease, enteric infections, and food allergies. The book provides overviews on current perspectives regarding the nature of inflammatory processes, inflammatory mediators, and other immune factors. It also describes a variety of experimental approaches that have been used to study the interactions between immune cells and smooth muscle or enteric nerves. The approaches include in vivo, as well as in vitro studies. Researchers involved in the general field of immunophysiology, as well as the more specific fields of gastrointestinal motility and inflammatory bowel diseases will find this book to be invaluable in their research.