Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

Heinrich: From the gastroenterologist's perspective, referrals to our Motility Laboratory are not restricted to the relatively clear-cut preoperative questions posed by upper and lower gastrointestinal (GI) surgeons, such as gastroesophageal reflux disease (GERD) and oesophageal motility disorders or faecal incontinence and obstructive defecation. Referring doctors request investigation of a wide range of symptoms such as unexplained epigastric pain, regurgitation, nausea and vomiting, as well as abdominal and anal pain. In many cases, a detailed history using a structured questionnaire can provide clues as to whether primary functional or organic pathology is present and, occasionally, point to the final diagnosis. However, upper and lower GI motility testing provides an objective description of path physiology of symptoms and can help diagnosing important conditions such as achalasia, GERD, rumination, and dyssynergic defecation