Functional Digestive Pathology

Functional disorders of the gastrointestinal tract are very common, accounting for between 20 and 30% of all medical visits relating to the digestive system.

What are functional gastrointestinal disorders?

These are motility disorders of the gastrointestinal tract which can result in severe discomfort, in some cases incapacitating the patient, and where conventional tests, such as gastrointestinal endoscopies and radiological tests, don’t detect organ disease. These patients come to see us after numerous endoscopic and radiological tests.

Gastrointestinal Disorder Services

Esophageal pH monitoring

pH monitoring is a technique consisting in introducing a probe into the oesophagus through the nose, in order to record acid concentration and measure it over a 24-hour period.

The probe is inserted under local anaesthetic and is left in place for 24 hours, with a portable pH monitor that records acid peaks and matches them to a diary kept by the patient. The software uses a statistical method to calculate the amount of acid produced, converting it into a score which the doctor can then interpret.

The most common reason for this technique being requested is gastro-oesophageal reflux, which affects up to 30% of the general population. These patients must undergo functional studies prior to anti-reflux surgery. Another common reason is to study chest pain of unknown origin.

Gastrointestinal disorders

Esophageal manometry

Esophageal manometry is a test carried out in addition to the pH monitoring test, to provide information on the contractions of the oesophagus and its peristalsis. It is a diagnostic test for oesophageal motor disorders and must be carried out on all patients requiring anti-reflux surgery, because the existence of such disorders could be a contraindication for this type of surgery. The technique also consists in inserting a special probe into the oesophagus through the nostrils. During its removal, the contractions of the oesophagus are calculated to verify that oesophageal peristalsis, which is responsible for pushing the food bolus to the stomach, is taking place correctly.

It is performed on patients with dysphagia and non-cardiac chest pain, and prior to anti-reflux surgery. Functional oesophageal motility disorders are diffuse oesophageal spasm, Nutcracker oesophagus, hypertensive distal oesophageal sphincter and achalasia.

Esophageal impedance

Esophageal impedance is performed with a special impedance probe, inserted in the same way as the pH monitoring probe and the manometry probe, which records the passage of the food bolus to the stomach. Its indications are more limited and it must be prescribed at specialist centers with special functional disorder units.

It’s a new technique that enables the movement and resistance of the food bolus to be recorded. It’s performed on patients who present with swallowing disorders, when conventional tests such as pH monitoring and manometry yield negative results.

Anorectal manometry

Anorectal manometry measures the contractions of the anus and involves studying the nerves to record the necessary information about how the pelvic floor and anal sphincters are functioning.

It is indicated for patients with faecal incontinence and chronic constipation. It’s a functional test that must be carried out before new therapies, like biofeedback, are implemented. It must also be requested prior to coloanal reconstruction surgery.