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Organizing and Developing a GI Motility Lab in Community Practice: Challenges and Rewards

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
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Abstract

Purpose of Review

Neurogastroenterology and motility is a rapidly evolving subspecialty that encompasses over 33% of gastroenterological disorders, and up to 50% of referrals to gastroenterology practice. It includes common problems such as dysphagia, gastroesophageal reflux disease, irritable bowel syndrome, chronic constipation, gastroparesis, functional dyspepsia, gas/bloating, small intestinal bacterial overgrowth, food intolerance and fecal incontinence Standard diagnostic tests such as endoscopy or imaging are normal in these conditions. To define the underlying mechanism(s)/etiology of these disorders, diagnostic motility tests are often required. These are best performed by well-trained personnel in a dedicated motility laboratory. Our purpose is to provide an up-to-date overview on how to organize and develop a motility laboratory based on our collective experiences in setting up such facilities in academia and community practice.

Recent Findings

A lack of knowledge, training and facilities for providing diagnostic motility tests has led to suboptimal patient care. A motility laboratory is the hub for diagnostic and therapeutic motility procedures. Common procedures include esophageal function tests such as esophageal manometry and pH monitoring, anorectal function tests suchlike anorectal manometry, neurophysiology and balloon expulsion, dysbiosis and food intolerance tests such as hydrogen/methane breath tests, and gastrointestinal transit assessment. These tests provide an accurate diagnosis and guide clinical management including use of medications, biofeedback therapy, neuromodulation, behavioral therapies, evidence-based dietary interventions and endoscopic or surgical procedures. Further, there have been recent developments in billing and coding of motility procedures and training requirements that are not well known.

Summary

This review provides a stepwise approach on how to set-up a motility laboratory in the community or academic practice and includes the rationale, infrastructure, staffing needs, commonly performed motility tests and their clinical utility, billing and coding strategies, training needs and economic considerations for setting up this service.

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Adapted from GI Kids & NASPGHAN, 2019

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Adapted from Gao, F. et al. (2018). Anal Methods,10:4329–4338 [81].

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Acknowledgements

Dr Rao is supported by NIH grants, U-01 DK 115572-03 and R01DK121003-02.

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Authors and Affiliations

  1. Atrium Health, Charlotte, NC, USA

    Jason R. Baker & Baharak Moshiree

  2. Neurogastroenterology and Motility Laboratory, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28209, USA

    Jason R. Baker

  3. Division of Neurogastroenterology, The Institute for Digestive and Liver Disease, Mercy Medical Center, Baltimore, MD, USA

    Bryan F. Curtin

  4. Division of Neurogastroenterology/Motility, Augusta University Medical Center, Augusta, GA, USA

    Satish S. C. Rao

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Contributions

Satish SC Rao – Manuscript design, manuscript preparation, review, and approval of final manuscript.

Jason R. Baker – Manuscript design, manuscript preparation, review, and approval of final manuscript.

Bryan Curtin – Manuscript design, manuscript preparation, review, and approval of final manuscript.

Baharak Moshiree – Manuscript design, manuscript preparation, review and approval of final manuscript.

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Correspondence to Satish S. C. Rao.

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Baker, J.R., Curtin, B.F., Moshiree, B. et al. Organizing and Developing a GI Motility Lab in Community Practice: Challenges and Rewards. Curr Gastroenterol Rep 24, 73–87 (2022). https://doi.org/10.1007/s11894-022-00838-5

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