Functional Gut Disorders Research Articles

Gastro-entero-hepatology in the next millennium

The scope of gastroenterology and hepatology now and its development into the next century are great and expanding. Only some of the many exciting improvements which are expected during the next few years can be discussed here. Progress in the microbial aetiology and novel targeted treatments for inflammatory bowel disease (IBD) will be paralleled by better understanding of functional upper and lower gut disorders, their neural control and neuropharmacological treatment. Technical developments in the pipeline include improvements in endoscopic and endosonographic equipment and techniques, including MR- or CT-based “virtual colonoscopy” to obviate many invasive diagnostic colonoscopies, and the remarkable self-propelled endoscope, which will worm its way to regions of interest in the bowel. In hepatology, transplantation, and vaccination for hepatitides will increase, and improved treatment of acute liver failure may involve bioreactors or cryopreserved human hepatocytes. Gastrointestinal oncology will progress through more extensive surgery, gene therapy and techniques such as mucosal resection. A target force of about 150 trained gastroenterologist/hepatologists will be needed in the Netherlands — one for every 100000 of the population.

Conscious perception of gut activity

Regional disturbances of motility in the gastrointestinal tract have been proposed as likely pathogenetic mechanisms for a number of functional gut diseases. However, not all patients with functional gut symptoms exhibit detectable dysmotility. Some investigators have therefore postulated that visceral hypersensitivity to regional luminal stimuli underlies symptoms. The results of emerging research suggest that a pathogenic role of visceral hypersensitivity in functional gut disorders is plausible but that the issue is extremely complex, in view of the interactions between neural control of gut motility, conscious perception of gut signals, and modulation at spinal and brain centers.