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Patel D, Safder SS, El-Chammas K, Kapavarapu P, Wheeler J, Mostamand S, Khlevner J, Darbar A. Pediatric Neurogastroenterology and Motility Services in North America: Neurogastroenterology and Motility Survey Report. J Pediatr Gastroenterol Nutr 2022; 74:593-598. [PMID: 35192576 DOI: 10.1097/mpg.0000000000003419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT To characterize the current availability and scope of pediatric neurogastroenterology and motility (PNGM) services in North America (NA), the NASPGHAN-NGM committee distributed a self-reporting survey through the NASPGHAN bulletin board and mailing listserv, to compile a list of NA centers offering PNGM services, PNGM training, and the types of diagnostic and therapeutic PNGM procedures and services. We received responses that 54 centers in NA offer some form of PNGM services. Previously, the NASPGHAN website had last updated information from 2015 listing 36 centers in the USA and 2 in Canada. The American Neurogastroenterology and Motility Society (ANMS) website had 16 PNGM centers listed in NA in 2021. Neither of these resources capture additional information regarding training, research, advanced diagnostics, and therapeutics, and all available PNGM services. Our data highlights the growth in the field of PNGM services, and the variability of their distribution throughout the continent.
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Affiliation(s)
- Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, MO
| | - Skaista S Safder
- Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando Health, orlando, FL
| | - Khalil El-Chammas
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Prasanna Kapavarapu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Justin Wheeler
- Division of Pediatric Gastroenterology, University of Utah, Salt Lake City, UT
| | - Shikib Mostamand
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University, School of Medicine and the Lucile Packard Children's Hospital
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Anil Darbar
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
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2
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Saboori S, Jarvis M, Baker J, Seminara B, Vickers D, Pacicco T, Moshiree B. Hard to Swallow Results. Dysphagia 2021; 37:863-867. [PMID: 34297152 DOI: 10.1007/s00455-021-10344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The American Neurogastroenterology and Motility Society (ANMS) proposed quality measures (QMs) for performance and interpretation of esophageal manometry (EM). We implemented a quality improvement (QI) study at a large community hospital to assess and improve procedural adherence and interpretation of EM studies based on the ANMS QMs using the Chicago Classification 3.0 (CC) Guidelines. For pre-intervention, three motility independent reviewers reinterpreted 60 EM studies conducted by community gastroenterologists without Tier II-III motility training from October to December 2018 for compliance with pre-procedural, procedural, and data interpretation ANMS QMs. In December 2018, we developed a pre-procedural form, educated nurses on EM procedural compliance, and provided preliminary pre-intervention results to gastroenterologists along with literature utilizing the CC 3.0 Guidelines. For post-intervention, we reinterpreted 54 EM studies from January to August 2019 and investigated whether they met QMs for data interpretation with respect to the CC Guidelines and resulted in appropriate treatment. We found a statistically significant improvement in procedural compliance among nursing staff for 30 s of swallows (76% post-intervention versus 12% pre-intervention, p < 0.001) and 7 evaluable swallows (94% post-intervention versus 53% pre-intervention, p < 0.001). However, quality metrics within data interpretation by physicians post-intervention showed mixed results. An incorrect diagnosis was made in 50% (n = 27)) of studies with 72% (n = 39) having at least one missing item based on the CC. The most missed diagnosis was fragmented peristalsis (30%, n = 29). Among the 39% (n = 21) of surgery referrals, 24% (n = 5) were incorrectly referred. Our study shows poor data interpretation by community gastroenterologists without formal motility training despite adequate performance by nursing staff. This further supports the need for a national ANMS certification process for formal HRM education.
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Affiliation(s)
- S Saboori
- Department of Internal Medicine at Atrium Health's Carolinas Medical Center, 5th Floor Medical Education Building, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - M Jarvis
- Department of Internal Medicine at Atrium Health's Carolinas Medical Center, Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - J Baker
- Department of Internal Medicine and Surgery at Atrium Health's Carolinas Medical Center, Charlotte, USA
| | - B Seminara
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - D Vickers
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - T Pacicco
- Atrium Health Gastroenterology and Hepatology, Charlotte, USA
| | - B Moshiree
- UNC School of Medicine-Charlotte Campus, Atrium Health Gastroenterology and Hepatology, Charlotte, USA
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Gyawali CP, Savarino E, Lazarescu A, Bor S, Patel A, Dickman R, Pressman A, Drewes AM, Rosen J, Drug V, Saps M, Novais L, Vazquez-Roque M, Pohl D, van Tilburg MAL, Smout A, Yoon S, Pandolfino J, Farrugia G, Barbara G, Roman S. Curriculum for neurogastroenterology and motility training: A report from the joint ANMS-ESNM task force. Neurogastroenterol Motil 2018; 30:e13341. [PMID: 29577508 DOI: 10.1111/nmo.13341] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/18/2018] [Indexed: 01/10/2023]
Abstract
Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency-based training curriculum developed by NGM experts is lacking. The American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and Motility (ESNM) jointly evaluated the components of NGM training in North America and Europe. Eleven training domains were identified within NGM, consisting of functional gastrointestinal disorders, visceral hypersensitivity and pain pathways, motor disorders within anatomic areas (esophagus, stomach, small bowel and colon, anorectum), mucosal disorders (gastro-esophageal reflux disease, other mucosal disorders), consequences of systemic disease, consequences of therapy (surgery, endoscopic intervention, medications, other therapy), and transition of pediatric patients into adult practice. A 3-tiered training curriculum covering these domains is proposed here and endorsed by all NGM societies. Tier 1 NGM knowledge and training is expected of all gastroenterology trainees and practicing gastroenterologists. Tier 2 knowledge and training is appropriate for trainees who anticipate NGM disorder management and NGM function test interpretation being an important part of their careers, which may require competency assessment and credentialing of test interpretation skills. Tier 3 knowledge and training is undertaken by trainees interested in a dedicated NGM career and may be restricted to specific domains within the broad NGM field. The joint ANMS and ESNM task force anticipates that the NGM curriculum will streamline NGM training in North America and Europe and will lead to better identification of centers of excellence where Tier 2 and Tier 3 training can be accomplished.
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Affiliation(s)
- C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - E Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - A Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - S Bor
- Department of Gastrenterology, Ege University, Izmir, Turkey
| | - A Patel
- Duke University School of Medicine and the Durham VA Medical Center, Durham, NC, USA
| | - R Dickman
- Division of Gastroenterology, Rabin Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Pressman
- Division of Gastroenterology, Brown University, Providence, RI, USA
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - J Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, Kansas City, USA
| | - V Drug
- Institute of Gastroenterology and Hepatology, University Hospital "St Spiridon", University of Medicine and Pharmacy "Gr T Popa", Iasi, Romania
| | - M Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Miami, Miami, FL, USA
| | - L Novais
- Neurogastroenterology and Gastrointestinal Motility Lab, New University of Lisbon, Lisbon, Portugal
| | - M Vazquez-Roque
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - D Pohl
- Klinik fur Gastroenterologie und Hepatologie, University of Zurich, Zurich, Switzerland
| | - M A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | - A Smout
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Yoon
- Division of Gastroenterology and Hepatology, University of Rochester, Rochester, NY, USA
| | - J Pandolfino
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - G Farrugia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - G Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - S Roman
- Digestive Physiology, Université de Lyon, Hospices Civils de Lyon, Lyon, France.,Digestive Physiology, Université de Lyon, Lyon I University, Lyon, France
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Vasant DH, Sharma A, Bhagatwala J, Viswanathan L, Rao SSC. Apprenticeship-based training in neurogastroenterology and motility. Expert Rev Gastroenterol Hepatol 2018; 12:215-222. [PMID: 29140124 DOI: 10.1080/17474124.2018.1406308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although neurogastroenterology and motility (NGM) disorders affect 50% of patients seen in clinics, many gastroenterologists receive limited NGM training. One-month apprenticeship-based NGM training has been provided at ten centers in the USA for a decade, however, outcomes of this training are unclear. Our goal was to describe the effectiveness of this program from a trainees perspective. Areas covered: We describe the training model, learning experiences, and outcomes of one-month apprenticeship-based training in NGM at a center of excellence, using a detailed individual observer account and data from 12 consecutive trainees that completed the program. During a one-month training period, 302 procedures including; breath tests (BT) n = 132, anorectal manometry (ARM) n = 29 and esophageal manometry (EM) n = 28, were performed. Post-training, all trainees (n = 12) knew indications for motility tests, and the majority achieved independence in basic interpretation of BT, EM and ARM. Additionally, in a multiple-choice NGM written-test paper, trainees achieved significant improvements in test scores post-training (P = 0.003). Expert commentary: One-month training at a high-volume center can facilitate rapid learning of NGM and the indications, basic interpretation and utility of motility tests. Trainees demonstrate significant independence, and this training model provides an ideal platform for those interested in sub-specialty NGM.
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Affiliation(s)
- Dipesh H Vasant
- a Division of Gastroenterology and Hepatology , Digestive Health Center, Augusta University, Medical College of Georgia , Augusta , USA.,b Division of Diabetes, Endocrinology & Gastroenterology , Manchester Academic Health Sciences Centre, University of Manchester , Manchester , United Kingdom
| | - Amol Sharma
- a Division of Gastroenterology and Hepatology , Digestive Health Center, Augusta University, Medical College of Georgia , Augusta , USA
| | - Jigar Bhagatwala
- a Division of Gastroenterology and Hepatology , Digestive Health Center, Augusta University, Medical College of Georgia , Augusta , USA
| | - Lavanya Viswanathan
- a Division of Gastroenterology and Hepatology , Digestive Health Center, Augusta University, Medical College of Georgia , Augusta , USA
| | - Satish S C Rao
- a Division of Gastroenterology and Hepatology , Digestive Health Center, Augusta University, Medical College of Georgia , Augusta , USA
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Affiliation(s)
- Sonia S Yoon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Braden Kuo
- Center for Neurointestinal Health, GI Motility Laboratory, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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6
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Affiliation(s)
- Satish S C Rao
- Section of Gastroenterology/Hepatology, Department of Internal Medicine, Medical College of Georgia, Georgia Regents University, Augusta, Georgia.
| | - Henry P Parkman
- Section of Gastroenterology/Hepatology, Department of Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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8
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Bergeron KF, Silversides DW, Pilon N. The developmental genetics of Hirschsprung's disease. Clin Genet 2012; 83:15-22. [PMID: 23043324 DOI: 10.1111/cge.12032] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 10/03/2012] [Accepted: 10/03/2012] [Indexed: 12/31/2022]
Abstract
Hirschsprung's disease (HSCR), also known as aganglionic megacolon, derives from a congenital malformation of the enteric nervous system (ENS). It displays an incidence of 1 in 5000 live births with a 4:1 male to female sex ratio. Clinical signs include severe constipation and distended bowel due to a non-motile colon. If left untreated, aganglionic megacolon is lethal. This severe congenital condition is caused by the absence of colonic neural ganglia and thus lack of intrinsic innervation of the colon due in turn to improper colonization of the developing intestines by ENS progenitor cells. These progenitor cells are derived from a transient stem cell population called neural crest cells (NCC). The genetics of HSCR is complex and can involve mutations in multiple genes. However, it is estimated that mutations in known genes account for less than half of the cases of HSCR observed clinically. The male sex bias is currently unexplained. The objective of this review is to provide an overview of the pathophysiology and genetics of HSCR, within the context of our current knowledge of NCC development, sex chromosome genetics and laboratory models.
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Affiliation(s)
- K-F Bergeron
- Molecular Genetics of Development Laboratory, Department of Biological Sciences, University of Quebec at Montreal, Canada
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Abstract
Abnormalities of gastrointestinal (GI) motor function contribute directly or indirectly to a number of common clinical problems and account for significant health care-related expenditure. Proper evaluation of patients who have suspected GI motility disorders is important to ensure a correct diagnosis and to embark on an appropriate plan of treatment. The GI motility laboratory serves as an important area for patient evaluation in gastroenterology and is an essential element in any comprehensive digestive disease program. This article addresses important concepts in setting up and running an efficient and practical GI motility laboratory.
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Affiliation(s)
- Henry P Parkman
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Parkinson Pavilion, 8th Floor, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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10
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Abstract
Abnormalities of gastrointestinal (GI) motor function contribute directly or indirectly to a number of common clinical problems and account for significant health care-related expenditure. Proper evaluation of patients who have suspected GI motility disorders is important to ensure a correct diagnosis and to embark on an appropriate plan of treatment. The GI motility laboratory serves as an important area for patient evaluation in gastroenterology and is an essential element in any comprehensive digestive disease program. This article addresses important concepts in setting up and running an efficient and practical GI motility laboratory.
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Affiliation(s)
- Henry P Parkman
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Parkinson Pavilion, 8th Floor, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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