Atrium Health, Charlotte, NC, USA.
Neurogastroenterology and Motility Laboratory, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28209, USA.
Curr Gastroenterol Rep. 2022 Jun;24(6):73-87. doi: 10.1007/s11894-022-00838-5.
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.
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. 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.
神经胃肠病学和动力是一个快速发展的亚专科，涵盖了超过 33%的胃肠疾病，以及多达 50%的胃肠病学就诊。它包括常见的问题，如吞咽困难、胃食管反流病、肠易激综合征、慢性便秘、胃轻瘫、功能性消化不良、气体/腹胀、小肠细菌过度生长、食物不耐受和粪便失禁。在这些情况下，内镜检查或影像学等标准诊断测试通常正常。为了确定这些疾病的潜在机制/病因，通常需要进行诊断性动力测试。这些最好由经过专门培训的人员在专门的动力实验室中进行。我们的目的是根据我们在学术和社区实践中建立这些设施的集体经验，提供有关如何组织和发展动力实验室的最新概述。
缺乏提供诊断性动力测试的知识、培训和设施导致患者护理不佳。动力实验室是诊断和治疗动力程序的中心。常见的程序包括食管功能测试，如食管测压和 pH 监测、肛肠功能测试，如肛肠测压、神经生理学和球囊排出、菌群失调和食物不耐受测试，如氢/甲烷呼气测试，以及胃肠道转运评估。这些测试提供了准确的诊断，并指导临床管理，包括使用药物、生物反馈治疗、神经调节、行为疗法、基于证据的饮食干预和内镜或手术程序。此外，动力程序的计费和编码以及培训要求最近也有了新的发展，这些发展并不为人所知。本综述提供了在社区或学术实践中建立动力实验室的分步方法，包括建立动力实验室的理由、基础设施、人员配备需求、常见的动力测试及其临床应用、计费和编码策略、培训需求以及建立这项服务的经济考虑因素。
