Motility and GI Laboratory Training

Goals and Objectives

All fellows are expected to be knowledgeable about the indications, complications, and limitations of interpretation of gastrointestinal manometry and other motility studies, esophageal pH studies, and hydrogen breath testing.

Method of Teaching

This knowledge in motility is imparted to the fellows primarily in the first year in two phases. The first, consisting mainly of didactic lectures, lays the theoretical foundation for disorders of the enteric nervous system and interpretation of motility studies. These lectures provide an understanding of the physiology of motility of the different areas of the gut, the brain-gut axis, and the physiology of visceral sensation. In addition they emphasize the clinical care of these patients including the recognition and treatment of the associated psychosocial factors in patients with functional bowel disease.

Fellows rotating in the pancreatobiliary and motility rotations in the third year will become familiar with breath hydrogen measurement techniques used to non-invasively evaluate for possible lactose intolerance, small bowel bacterial overgrowth, and assess oral-cecal transit time. Subsequently, on a weekly basis, these studies are reviewed along with a faculty member who teaches the significant manometric features of major motor disorders of the esophagus and anal sphincter. During this time, fellows develop an understanding of the features of pH testing including parameters of reflux and the significance of symptoms. Trainees will also be provided with an appropriate longitudinal outpatient experience in which patients with possible motility disorders are evaluated and managed. This experience will include exposure to making decisions as to appropriate testing, interpreting test results, and treating the patient under the guidance of attending faculty. Adjunctive training in motility disorders takes place in radiology conference or on radiology electives in which transit (shape) studies and defecograms are reviewed.

For all the tests that are conducted in the clinical GI laboratory, fellows will become familiar with the use and calibration of the equipment, placement of tubes or catheters, and the interpretation and reporting of results.

Method of Evaluation

Competence in GI motility and the associated tests, as well as other GI laboratory diagnostic tests, is evaluated by the faculty in attendance who provides ongoing feedback as well as completing evaluation forms as previously described. Additional evaluation of fellows’ ability to diagnose and manage patients by utilizing information acquired from such tests is provided by faculty supervising in the outpatient clinics or on the consult services.