Internationally renowned medical specialists in our team work closely with well-experienced multidisciplinary teams, using advanced medical technology and precision testing for diagnosis and treatment.  Included in the team are specialist researchers who have been continuously researching into the nature of diseases and publishing research papers in international medical journals. With their insights into the diseases, even more precise diagnosis and treatment can be achieved. Our Gastrointestinal Motility Center services cover all the following  problems related to the gastrointestinal system:
 

Gastrointestinal motility diseases, which involve various organs from the esophagus to the rectum, include the following:

• Swallowing difficulty
• Gastroesophageal reflux disease (GERD) -  Patients may experience symptoms similar to those of ear, nose and throat diseases such as burning throat and constant tight throat, those of lung diseases such as chronic cough, and those of heart diseases such as chest pain but with no known cause.
• Irregular bowel movements including chronic constipation and fecal incontinence – While chronic constipation is a common condition in the general population, in some people, the condition may be so troublesome and not respond to treatment by general practitioners.  With proper diagnosis and treatment, the constipation in these patients can improve, if not completely cured.  An anorectal manometry can help determine that the problem is due to anorectal dyssynergia. In this way, biofeedback therapy or straining training by a team of specialists may offer great help. It is found that 60% of patients have been completely cured of constipation while the rest have improved, requiring fewer laxatives.
• Chronic abdominal distension - This is mainly caused by abnormal gastrointestinal function but endoscopy cannot detect abnormalities.  With proper diagnosis and treatment, after finding the real cause, the condition may be completed cured or the symptoms may be alleviated, less worrisome for the patients.

Diagnosis of gastrointestinal motility diseases thus requires expertise in special examination by highly-skilled doctors. We can provide services related to a whole range of gastrointestinal problems as follows.

Upper gastrointestinal motility disorders
Esophageal disorders

• Achalasia,  a swallowing disorder caused by loss of function of the esophagus and lower esophageal sphincter
• Dysphagia and esophageal motility disorder
• GERD (gastroesophageal reflux disease) and atypical GERD) such as chronic cough, non-cardiac chest pain, and difficulty swallowing

Stomach disorders

• Dyspepsia, or indigestion
• Gastroparesis, a condition where the stomach cannot empty in the normal way (or a condition where the stomach contracts too slowly)
• Dumping syndrome, a condition where food moves from the stomach into the small bowel too quickly
• Chronic vomiting syndrome, a condition with no known cause

Lower gastrointestinal motility disorders
Colon disorders

• Chronic constipation
• Irritable bowel syndrome (IBS)

Small intestine disorders

• Intestinal pseudo-obstruction
• Intestinal dysmotility
• Small intestinal bacterial over growth, SIBO)

Colon and rectum disorders and pelvic floor dysfunction

• Fecal incontinence
• Pelvic floor dyssynergia – The lack of control over pelvic floor muscles to contract and relax as needed results in constipation or fecal incontinence. This is treatable with biofeedback therapy, bowel movement training with a special instrument.
• Delayed colonic transit – In dealing with this colonic motility disorder where the food waste remains in the colon longer than usual, a colonic transit study can determine how quickly material moves through the colon and a colonic manometry can assess the strength of the colon’s movements or how it contracts.

Gastrointestinal Motility Center, Bumrungrad International Hospital, uses the following modern medical diagnostics technologies:

1. Manometry study of the gastrointestinal system:

• Esophageal manometry studies the esophageal motility and the function of both the upper and the lower esophageal sphincter in patients with swallowing problems, chest pain, or suspected esophageal disease. It can also be used in GERD patients before an esophageal pH (impedance) test.
• Antroduodenal manometry measures the function of the stomach and the duodenum in patients possibly with stomach and duodenum dysfunction such as those with vomiting, abdominal bloating and dissension with no known cause or in patients with suspected intestinal obstruction but undetected by endoscopy or x-ray.
• Anorectal manometry is performed in patients with chronic constipation suspected of colonic dysfunction or dysfunction of the lower diaphragm or the anal sphincter, resulting in defecation difficulty. 
  It is also done in infants with constipation since birth possibly as a result of congenitally missing nerve cells in the muscles of the baby's colon.
• Colonic manometry is a diagnostic test to determine the cause of slow or delayed colonic transit, which helps in deciding if the patient’s constipation problem is better treated with medication or with colon removal surgery

2. 24hr esophageal pH-impedance testing – two methods:

• A small catheter is placed through the nose into the esophagus, and left there to measure the amount of acid and non-acid reflux for 24 hours. This is followed by digital analysis.
• In a capsule endoscopy, a capsule is inserted through the gastrointestinal endoscope and then attached to the wall of the esophagus.  The capsule sends radiofrequency signals to a receiver outside the patient's body.  Once the data is collected, the capsule will be released and passed naturally.

3. H2 breath test is used to detect common digestive problems including the following:

• Small intestinal bacterial overgrowth (SIBO), which can cause bloating or chronic diarrhea
• Lactose malabsorption or fructose malabsorption
• Orocecal transit time, measuring intestinal tract motility

4. Saliva flow rate test helps determine if there is too little saliva, a cause of chronic sore or burning throat, causing patients to have symptoms similar to those of acid reflux.

5. Anorectal biofeedback training for those with constipation and fecal incontinence

• Constipation: About 40% of constipation cases is caused by improper defecation, straining to have a bowel movement while contracting the anal sphincter muscles so the push is not enough for the bowels to empty. In this training, doctors or nurses will help teach the patient how to strain and relax.
• Fecal incontinence is often found in the elderly. Some may not feel they are defecating. Others may want to contract the anal sphincter muscles to hold the stool, but do not know how to and strain instead. Doctors or nurses, using modern instruments and techniques, will help train the patients how to respond when they feel the stool reaches the anus and contract the anal sphincter muscles properly.

Medical specialists and multidisciplinary professionals work closely together in teams to provide treatment and care for patients. Our teams consist of the following:

• Gastrointestinal motility specialists
• Surgeons
• Radiologists
• Pathologists
• Rehabilitation medical specialists
• Physical therapists
• Dietitians/Nutritionists
• Pharmacists specializing in medicines for gastrointestinal diseases
• Nurses trained and experienced in caring for gastrointestinal patients