Though they represent some of the most common disorders seen in clinical practice among both children and adults, what are commonly referred to as functional gastrointestinal disorders (FGIDs) remain poorly understood and represent a considerable challenge for the clinician and the researcher alike. Disorders of gastrointestinal mo-tility are more discrete and better defined but suffer from a paucity of effective therapeutic options. For historical reasons FGIDs and motility disorders are often bracketed together and, while dysmotility may certainly be a factor in the genesis of symptoms in a variety of FGIDs, other factors ranging from visceral sensation to autonomic dysfunction and cerebral representation of visceral events, for example, may also be operative in the FGIDs. Consequently, some have proposed a variety of other terms to encompass the FGIDs within a more pathophysiological framework, such as enteric neurosensory or visceral sensorimotor disorders. None has gained widespread acceptance as yet and, for now, the FGIDs continue as symptom-based disorders of uncertain etiology. The broader term 'neurogastroenterology' certainly encompasses most aspects of both motility and FGID's and has been widely adopted to describe the field of study that relates to these diverse entities. Why, then, is this book called 'Functional and Motility Disorders of the Gastrointestinal Tract' and not 'Neurogastroenterology"? The answer is a simple one and relates to the basic purpose of this volume, which is to be clinical in focus. Thus, the title and each of the chapters that comprise the book emphasizes a clinical rather than a pathophysiological approach to problems, be they functional or motility in nature or lie somewhere in between. This is not to denigrate pathophysiology but rather to facilitate access for the practicing clinician; a reader who will readily identify clinical problems be they symptom-based, such as dysphagia or difficult defecation or contextual such as the problems that arise in the intensive care unit or post-operatively. Indeed, clinically important aspects of pathophysiology are dealt with in detail in contribution such as 'Psycho-social aspects of functional gastrointestinal disorders'.A\To achieve these goals we have assembled an all-star cast of internationally renowned experts in their given areas; where appropriate, diagnosis and management are dealt with in relation to a given clinical problem and general overviews of broadly relevant therapeutic approaches are also provided.A\We believe that this book will be a valuable companion to the busy clinician as he or she struggles with challenging diagnostic and therapeutic issues and that it also provides a guide, for the clinical investigator, to the many questions that remain unanswered. Earnonn M.M. Quigley, Houston, Tex.

Preface VII

Oropharyngeal Dysphagia and Swallowing Dysfunction 1

Nonobstructive Dysphagia 14

Gastroparesis 25

The Role of Gastric Sensorineural Dysfunction in Functional Dyspepsia 38

Chronic Intestinal Pseudo-Obstruction: A Neuropathological Approach 45

Small Intestinal Dysmotility, Its Role in Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth: Assessment and Management 55

When and How Should We Study Colonic Motility? 65

Difficult Defecation: What Really Helps to Assess Dysfunction and Guide Therapy 82

Functional Gastrointestinal Disorders: The Mind-Body Dimension 95

The Role of Psychosocial Factors in Functional Gastrointestinal Disorders 104

The Pharmacology of the Gut-Brain Axis: Prospects for Future Therapeutic Progress? 117

Specific Clinical Contexts - Part 1 :The Intensive Care Unit 130

Specific Clinical Contexts - Part 2: The Patient with Neurological Disease 141

Specific Clinical Contexts - Part 3: The Child with Neurodevelopmental Delay 150

Specific Clinical Contexts - Part 4: The Postoperative Patient 163

Author Index 170

Subject Index 171

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