Unveiling the Unseen: Building a Neurogastroenterology Unit - Current Challenges in Clinical Practice

Neurogastroenterology disorders, also known as "Disorders of Gut-Brain Interaction" are gastrointestinal disorders that comprise a wide range of symptoms such as dysphagia, chest pain, heartburn, abdominal pain, nausea and vomiting, bloating, constipation, diarrhea or stool discharge. Scarcity of recognition, knowledge and training leading to the underdiagnosis of these conditions is associated with increased referrals to gastroenterologists or emergency room visits, along with a dramatic rise in healthcare costs and impaired quality of life. Despite advances in endoscopy and radiology, motility and pH impedance procedures remain the cornerstone of an accurate "Disorders of Gut-Brain Interaction" diagnosis, but these procedures need to be performed by well-trained personnel in a dedicated motility unit, with high-performance equipment. The primary motility procedures include high-resolution esophageal manometry and pH monitoring for esophageal function, high-resolution anorectal manometry and balloon expulsion tests for anorectal function, as well as hydrogen/methane breath tests for identifying dysbiosis and food intolerances. The purpose of this article is to highlight the importance of establishing a Neurogastroenterology and Motility Unit, and to provide an up-to-date overview on the main issues encountered when setting up a motility laboratory in the community or academic practice, including considerations for personnel training, equipment, and commonly performed motility procedures and their clinical usefulness.