Diagnosing motility disorders of the upper gastrointestinal tract

The past decade has witnessed an exponential growth of knowledge about upper gastrointestinal motility. The elucidation of the clinical problems is based on remarkable morphophysiologic, clinical, diagnostic, and pharmacotherapeutic advances. New approaches rely on a more sensitive application of manometric evaluation which has allowed identification of more subtle abnormalities of motility, as well as appreciation of the role of scintigraphic studies to measure transit through the esophagus, combined with the standard use of the cine-esophagogram modified to assess a solid bolus. New techniques to evaluate gastric motility include myoelectric gastrography and administration of isotope-labeled meals. These advances have been enhanced by the advent of prokinetic therapeutic agents, such as metoclopramide and domperidone. Evaluation of intestinal motility involves the use of intraluminal pressure sensing catheters, as well as methods to measure transit times. The standard hydrogen breath test as a noninvasive study of small intestinal transit time has been supplemented by an isotope-labeled liquid meal. Identification of clinical states with delayed and rapid small bowel transit times will have therapeutic implications in the future.