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Despite the fact that functional bowel disorders (FBDs) are the most common gastrointestinal conditions, neurogastroenterology has for years been the Cinderella subspecialty in gastroenterology, and one of the least popular specialities among trainees in gastrointestinal (GI) surgery. Is this all about to change?
Approximately 25% of the adult population suffers from FBDs, and yet the specialty is poorly developed, and research funding is relatively limited compared with subspecialties such as inflammatory bowel disease or hepatology. The cause of this indifference relates, largely, to the lack of effective treatments, this in turn being ultimately due to the lack of understanding of pathophysiology. While advances in molecular biology, imaging and endoscopy have revolutionised the characterisation and treatment of many GI disorders, it can be argued that there has been little progress in understanding the dysmotile gut. The causes of this are understandable. Full thickness biopsy of the gut to allow study of the myenteric neuromusculature is rarely possible. Functional studies of the gut have been inadequate due to the tortuous and extensive nature of the organ and the need to study it over prolonged periods of time (since visualisation of gut function over minutes or even hours is inadequate to understand abnormal physiology). The inability to understand the molecular, biochemical and neuromuscular dysfunction in these conditions has led to treatments that are ineffective. There is, of course, little job satisfaction trying to manage conditions where there are inadequate treatments.
New developments: the next 5 years
Invasive diagnostic procedures are less than ideal in the assessment of gut dysmotility, as they usually alter normal function and cannot be used for prolonged measurement. Technological refinements will provide an increased ability to study motility non-invasively. Improvements in dynamic MRI scanning will allow detailed analysis of gastric, small bowel and colonic activity in an unprepared state (though only for short periods of …
Competing interests YY has received speaker fees from Shire and Almirall. Research support received from Medtronic.
Provenance and peer review Commissioned; internally peer reviewed.