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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 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.
First published in 1943, Vitamins and Hormones is the longest-running serial published by Academic Press. The Editorial Board now reflects expertise in the field of hormone action, vitamin action, X-ray crystal structure, physiology, and enzyme mechanisms. Under the capable and qualified editorial leadership of Dr. Gerald Litwack, Vitamins and Hormones continues to publish cutting-edge reviews of interest to endocrinologists, biochemists, nutritionists, pharmacologists, cell biologists, and molecular biologists. Others interested in the structure and function of biologically active molecules like hormones and vitamins will, as always, turn to this series for comprehensive reviews by leading contributors to this and related disciplines. This volume focuses on insulin and IGFs. - Longest running series published by Academic Press - Contributions by leading international authorities
The enteric nervous system (ENS) is a complex neural network embedded in the gut wall that orchestrates the reflex behaviors of the intestine. The ENS is often referred to as the “little brain” in the gut because the ENS is more similar in size, complexity and autonomy to the central nervous system (CNS) than other components of the autonomic nervous system. Like the brain, the ENS is composed of neurons that are surrounded by glial cells. Enteric glia are a unique type of peripheral glia that are similar to astrocytes of the CNS. Yet enteric glial cells also differ from astrocytes in many important ways. The roles of enteric glial cell populations in the gut are beginning to come to light and recent evidence implicates enteric glia in almost every aspect of gastrointestinal physiology and pathophysiology. However, elucidating the exact mechanisms by which enteric glia influence gastrointestinal physiology and identifying how those roles are altered during gastrointestinal pathophysiology remain areas of intense research. The purpose of this e-book is to provide an introduction to enteric glial cells and to act as a resource for ongoing studies on this fascinating population of glia. Table of Contents: Introduction / A Historical Perspective on Enteric Glia / Enteric Glia: The Astroglia of the Gut / Molecular Composition of Enteric Glia / Development of Enteric Glia / Functional Roles of Enteric Glia / Enteric Glia and Disease Processes in the Gut / Concluding Remarks / References / Author Biography
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.
Handbook of Gastrointestinal Motility and Functional Disorders is a user-friendly handbook that reviews the latest and most up-to-date information on the evaluation of symptoms and diagnostic tests of GI motility and functional GI disorders and a practical approach on how to treat these disorders. Each chapter is written by an international expert in the field who was carefully chosen for his or her renowned scientific and clinical expertise. The book brings together the essence of science and art in the practice of neurogastroenterology and GI motility. The chapters are enriched with algorithms, tables, and figures to enhance learning and readability. Each chapter follows a specific outline; chapters on symptoms follow the format of definition, pathophysiology, and evaluation of the symptoms, whereas the chapters on specific disorders follow the format of definition, diagnosis, and treatment. This allows for quick reading of the various chapters and to gain up-to-date knowledge of the topic. Each chapter also includes extensive color pictures and illustrations of each test involved and descriptions of how to perform and interpret the motility tests that are incorporated into patient care decisions. Handbook of Gastrointestinal Motility and Functional Disorders by Drs. Satish S. C. Rao, Henry P. Parkman, and Richard W. McCallum will be useful for practicing physicians, junior academicians, GI fellows, young faculty, motility laboratory personnel, surgeons, internists, physician assistants, family practitioners, and nurse practitioners who all encounter the common problems of dysphagia, heartburn, nausea, vomiting, abdominal pain, irritable bowel syndrome, constipation, and fecal incontinence in their daily practice. The update on management and therapy completes the Handbook of Gastrointestinal Motility and Functional Disorders and explains how to integrate this diagnostic information into decision making, and how to translate this to day-to-day patient care.
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.
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.