Adopting the Latest Diagnostics for Digestive Disorders

At a Glance

  • UVA Motility Laboratory offers a full spectrum of diagnostic tests for GI disorders
  • Based on evolving standards, the lab is adopting new approaches to some diagnostic tests
  • Hydrogen breath tests and anorectal manometry are two of the tests that have seen recent improvements
  • UVA is also working with colleagues and other experts in the field to improve the treatment of constipation and fecal incontinence

Given the complex chain of events required to move food through the gastrointestinal tract, convert it to nutrients and void the resulting wastes, it is a wonder that most people never give digestion and defecation a second thought. When these processes go awry, the consequences can be life-threatening in the case of diverticulitis and gastrointestinal bleeding, but are always disruptive and unpleasant.

The UVA Motility Laboratory offers a full spectrum of diagnostic tests that can help gastroenterologists pinpoint the causes of gastrointestinal disorders like these and pave the way for appropriate treatment. Some of the advanced diagnostic tests being used at UVA include esophageal manometry to measure the function and strength of muscles in the esophagus; pH impedance tests for acid reflux; and breath tests to evaluate for small intestinal bacterial overgrowth, as well as lactose, fructose and fructans malabsorption. The lab is now focused on expanding its resources and keeping abreast of the latest evolution in evidence-based care.

A Better Test for SIBO
“There are some areas of testing where standards are evolving quickly,” says Jeanetta Frye, MD, director of the Motility Laboratory. “We are working hard to ensure that we apply the latest insights to the care of our patients.”

For instance, Frye and her colleagues use glucose as a substrate for the hydrogen breath test for small intestinal bacterial overgrowth (SIBO) in response to studies that report a high number of false positives with lactulose. Based on evidence pointing to its effectiveness, they also prescribe a diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to their patients as well as antibiotic therapy when appropriate.

Improving Anorectal Manometry
Another example of evolving GI diagnostic technology is anorectal manometry, a test that helps determine if constipation or incomplete evacuation is caused by dyssynergic defecation, an inability to coordinate the activity of the abdominal, rectoanal and pelvic floor muscles. Anorectal manometry can also be used to diagnose fecal incontinence caused by damage to the anal sphincter and the muscles that control it.

During the last decade, the catheters used in anorectal manometry have gone through several generations of improvements to provide better spatial resolution of the sphincter pressure profile and more precise diagnoses. “We are in the process of revising our protocols and upgrading our equipment to more accurately characterize patients with constipation and fecal incontinence,” Frye says.

Collaboration Is Key to Better Outcomes
The Motility Lab has also been working to expand its capacity to treat these conditions. For instance, although dyssynergic defecation has been addressed with fiber supplements and laxatives, the most effective therapy for patients with dyssynergic defecation is biofeedback, which helps patients relearn how to coordinate their muscles to produce a bowel movement. UVA is working with a leading expert in the field, Satish Rao, MD, PhD, at Augusta University in Georgia, to introduce these techniques at UVA.

“Making the latest tests and treatments available to our patients is critical, but so is being able to tap the experience of expert specialists,” Frye says. “At UVA, we have the ability to pull in colleagues in such fields as urogynecology and colorectal surgery as needed in our efforts to improve outcomes for our patients.”