>> TO PARAPHRASE THE COMMERCIAL, YOU SHOULD ENJOY THE GO.

WHAT IF YOU ARE ONE OF THOSE WHO CAN'T GO?

WHAT DO YOU DO THEN?

STAY WITH US AS WE TALK ABOUT GASTROINTESTINAL DISMOTILITY WITH GASTROENTEROLOGIST Dr. THOMAS ABELL NEXT ON KENTUCKY HEALTH.

>> KENTUCKY HEALTH IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

♪ ♪ >> ADMITTEDLY, AND FOR MANY REASONS, I AM FASCINATED BY THE COMMERCIAL THAT FEATURES A FAMILY OF BEARS WHO ARE PREOCCUPIED WITH CLEANLINESS AS THEY SAY, AFTER THE GO.

THEIR ONLY CONCERN IS HOW TO REMAIN CLEAN AFTER DEFEND DEFEND AN ACTION THAT MOST OF US TAKE FOR GRANTED.

THE GASTROINTESTINAL OR G.I.

AN ACTION THAT MOST OF US TAKE FOR GRANTED.

THE GASTROINTESTINAL OR G.I.

TRACT IS A LONG CONTINUOUS TUBE THAT BEGINS AT THE MOUTH AND ENDS AT THE ANUS.

NORMALLY WHAT WE CONSUME MOVES IN AN ABNORMAL DIRECTION.

WHAT WE SWALLOW MOVES IN ONE DIRECTION FROM THE MOUTH TO THE ANUS.

WHEN THIS PROCESS FUNCTIONS PROPERLY, WE GO ABOUT OUR LIVES NEITHER ENCUMBERED NOR CONCERNED ABOUT THE INTRICATE AND COORDINATED INTERPLAY TAKING PLACE WITHIN OUR G.I.

TRACT.

HOWEVER, WHEN FOR A MULTITUDE OF REASONS, THERE IS DISRUPTION IN THE FLOW OF MATERIAL WITHIN THE G.I.

TRACT, THINKING ABOUT THE GO, BECOMES A PARAMOUNT CONCERN AND NOT BECAUSE WE NEED THE RIGHT TOILET PAPER TO BE CLEAN, EITHER.

TO HELP US UNDERSTAND THE PROCESS OF MOVEMENT WITHIN THE GASTROINTESTINAL TRACT, HOW THINGS CAN GO WRONG AND TALK ABOUT OLD AND NEW TREATMENTS TO GET US BACK ON COURSE, WE HAVE AS OUR GUEST TODAY Dr. THOMAS ABELL.

A GRADUATE OF THE UNIVERSITY OF SOUTH DAKOTA MEDICAL SCHOOL.

HE DID HIS INTERNSHIP AT SOUTHERN ILLINOIS UNIVERSITY HOSPITAL AND RESIDENCY IN INTERNAL MEDICINE AT THE OHIO STATE UNIVERSITY HOSPITALS AND BAPTIST MEMORIAL HOSPITAL OF THE UNIVERSITY OF TENNESSEE IN MEMPHIS.

HE DID TWO GASTROINTESTINAL FELLOWSHIPS AT THE MAYO CLINIC AND THE UNIVERSITY OF TENNESSEE MEDICAL CENTER IN MEMPHIS.

Dr. ABELL IS CURRENTLY A PROFESSOR IN THE DEPARTMENT OF MEDICINE AND THE AUTHOR M.D.

CHAIR IN GASTROENTEROLOGY AT THE LOUISVILLE SCHOOL OF MEDICINE.

Dr. ABELL.

TOM, THANKS FOR BEING WITH US TODAY.

>> MY PLEASURE.

>> HOW DOES A NICE FELLOW LIKE YOU GET INVOLVED IN GASTROINTESTINAL MOTILITY?

>> IT GOES BACK TO MY DAYS AS A PRIMARY CARE DOCTOR WHICH I STARTED OUT WANTING TO DO PRIMARY CARE AND TEACH PRIMARY CARE BUT MY RESEARCH PROJECT AT OHIO STATE WAS ON COMMON PROBLEMS LIKE REFLUX, ABDOMINAL PAIN, CONSTIPATION.

WE SEE THESE ALL THE TIME.

IN PRIMARY CARE.

AND I THOUGHT THAT MAYBE WE COULD FIND SOME SOLUTIONS TO THOSE PROBLEMS.

>> YOU KNOW, I'M SURE BACK IN YOUR DAYS IN PRIMARY CARE, BECAUSE WERE YOU DOING THAT BEFORE YOU GOT INTO THE GASTROENTEROLOGY SIDE OF THINGS.

YOU MUST HAVE BEEN ASKED A QUESTION THEN AND NOW: HOW OFTEN AM I SUPPOSED TO HAVE A BOWEL MOVEMENT?

SO HOW DO YOU ANSWER THAT QUESTION?

>> THAT'S A GREAT QUESTION BECAUSE IT'S VERY PERSONALIZED.

EVERY PERSON, JUST LIKE EVERYBODY HAS THEIR OWN SIGNATURE AND ORGANISMS INSIDE THE SO CALLED STOOL BIOME, EVERYBODY HAS A DIFFERENT PATTERN FOR MOVING THEIR BOWELS.

WHEN IT'S A PROBLEM IS WHEN IT'S CONSCIOUS TO THE PERSON THAT BOTHERS THEM AND THEN THAT'S A PROBLEM.

>> SO IT IS NOT LIKE YOU HAVE TO HAVE TWO A WEEK THREE EVERY DAY, ANYTHING LIKE THAT.

IT'S WHAT IS NORMAL FOR THAT INDIVIDUAL.

>> YEAH.

>> I WAS A LITTLE NERVOUS WHEN YOU SAID IT'S LIKE FINGERPRINT AND I WAS GOING TO HAVE TO GO IN AND LOOK AT THE STOOL FOR EVERYBODY.

THAT'S HOW WE TELL SOMEBODY.

NO, NOT THAT?

GOOD.

WITH THAT IN MIND, WHAT IS DISMOTILITY THEN?

>> THAT'S A GREAT QUESTION.

TO TRY TO ANSWER THAT, TALK ABOUT NORMAL MOTILITY WHICH NORMALLY WE ARE NOT AWARE OF.

WE EAT, WE MOVE OUR BOWELS.

WE HOPEFULLY DON'T THINK ABOUT IT AT ALL.

BUT DISMOTILITY MEANS IRREGULAR NON-FUNCTIONING MOVEMENT FROM ORAL ABORAL AND THAT CAN BE DUE TO ALL KINDS OF THINGS.

SINCE THE G.I.

TRACT IS SUCH A LONG MUSE CAR TUBE, ANYTHING THAT AFFECTS MUSCLE IN THE BODY, ANYTHING IN THE BODY, INCLUDING HORMONAL AND ANTIBODIES AND CHANNELS, ALL THESE THINGS AS THE STOOL BIOME, ALL THOSE ORGANISM LIVING INSIDE THE GUT.

ANY OF THOSE THINGS CAN CAUSE PROBLEMS.

>> I ALWAYS THOUGHT ONE OF THE GREAT LUXURIES OF BEING A SURGEON AND IN PARTICULAR A COLORECTAL SURGEON, WHENEVER OPENING AN ABDOMEN, I WAS ALWAYS FASCINATED TO LOOK AND SEE PERCOLATION OF ACTIVITY OF THE SMALL BOWEL, AND THE COLON.

HOW THESE THINGS MOVE.

I MUST ADMIT IT'S FASCINATING.

SO WHAT IS GOING ON WITH THAT PAIR STOLLIC ACTIVITY WITH WE SEE THIS CONTRACTION TAKING PLACE THERE IS AN INTRINSIC ELECTRICAL ACTIVITY IN THE G.I.

TRACT JUST LIKE THE HEART.

EVERYBODY IS KIND OF AWARE OF THAT WITH THE HEART AND ELECTROCARDIO GRAHAMS AND THE FACT THAT YOU CAN GET ELECTRICAL PROBLEMS.

YOU CAN GET THE SAME PROBLEMS IN THE G.I.

TRACT.

ORDINARILY, THERE IS REGULAR ELECTRICAL ACTIVITY THAT IS THERE BUT WHENEVER CONDITIONS ARE RIGHT YOU GET THE CONTRACTION AND IT INCREASES IN AMPLITUDE AND STRENGTH AND THEN THINGS MOVE ALONG.

BUT IT'S VERY INTRICATE.

THERE ARE MORE NEURONS IN THE G.I.

TRACT THAN PROBABLY IN THE BRAIN.

SO THE GUT-BRAIN ACCESS IS A VERY DELICATE SYSTEM ANYTHING CAN GO WRONG.

>> I ALWAYS TOOK PRIDE WHEN SOMEBODY CALLED ME A BUTT HEAD BECAUSE OF ALL THE NESHES IN THE TRACT.

THAT IS A COMPLIMENT.

WHAT IS THE STIMULUS FOR THESE NERVES TO TELL THE INTESTINAL TRACT TO CONTRACT?

>> THAT'S ANOTHER GREAT QUESTION.

THERE IS ACTUALLY TWO MAIN AREAS OF MOTILITY IN TERMS OF THE PHYSIOLOGY.

ONE IS WHEN YOU ARE FASTING, WHEN YOU HAVEN'T EATEN, THE RHYTHMICAL CONSTRAXES-- CONTRACTIONS EVERY 90 TO 120 MINUTES WHICH GOES FROM THE ESOPHAGUS DOWN TO THE ANUS AND MOVES THINGS ALONG.

WHEN YOU EAT, IT BECOMES A TOTALLY DIFFERENT MECHANICS CALLED THE FED STATE.

AND NOT SO MUCH IN THEY SOVIET FUSS THOUGH IT IS CRUCIAL TO BRINGING FOOD DOWN INTO THE STOMACH BUT IN THE STOMACH THAT CONTRACTIONS CHANGE IN THE SMALL BOWEL, THEY CHANGE IN THE COLON.

SO THAT THAT DIFFERENCE IN PHYSIOLOGY WAS NOT APPRECIATED LET'S SAY 100 YEARS AGO AND WITH WORK AND ANIMALS WHICH HAVE BEEN VERY IMPORTANT, AND HUMANS NOW WE HAVE A MUCH BETTER UNDERSTANDING OF THAT THERE IS A LOT OF REASONS THEY COULD HAVE A PROBLEM.

SYSTEMIC PROBLEMS LIKE DIABETES OR A PROBLEM LIMITED TO THE G.I.

TRACT.

>> IS THERE SOMETHING THAT TELLS ONE AREA TO CONTRACT AND ANOTHER AREA TO RELAX?

SO THAT YOU DON'T HAVE THIS DISCORD ACT ACTIVITY?

HOW DOES THAT PROCESS HAPPEN?

>> IT'S VERY INTERESTING.

THREE PARTS.

THE CENTRAL PART, THE BRAIN IS KIND OF AWARE OF EVERYTHING THAT HAPPENS.

THERE IS THE AUTONOMIC SYSTEM, THE AUTOMATIC NERVOUS SYSTEM THAT CONTROLS THINGS AND THIN THE SYSTEM THAT HAS NEURONS.

NOT ONLY THE HEAD BUT THE SPINAL CHORD AND IT IS AN INTRICATE SYSTEM THAT WORKS, HOPEFULLY SEAMLESSLY WITHOUT US BEING AWARE OF IT UNLESS THERE IS A PROBLEM AND THEN WE OFTEN TIMES ARE QUITE AWARE.

AND NEED HELP.

>> SO YOU MENTIONED-- OKAY, SO WE HAVE CENTRAL, AUTONOMIC, AND ENTERIC.

THE NERVES IN THE GUT.

ARE THERE ANYTHING OUTSIDE OF THE THAT CAN IMPACT MOTILITY?

>> SURE.

HORMONES ARE CRUCIAL.

AND PEOPLE ARE NOW AWARE OF SOME OF THESE AMAZING DRUGS THAT WE HAVE NOW FOR WEIGHT LOSS AND DIABETES AND HEART DISEASE THAT ACTUALLY WORK ON HORMONAL ACTIVITY.

SO HORMONES ARE IMPORTANT.

THEY'RE ALSO VARIOUS ANTIBODIES THAT CONTROL THE MOVEMENT FOR MUSCLE CONTRACTIONS.

THESE ARE CALLED CHANNELS, CALCIUM POTASSIUM SODIUM CHANNELS.

AND THOSE CAN GET DISRUPTED AS WELL CAUSE BE PROBLEMS.

SO THERE ARE MANY, MANY THINGS THAT CAN GO WRONG, UNFORTUNATELY.

>> WHAT ABOUT STRESS?

>> STRESS, TO ME, IS LIKE POVERTY AND DISEASE, IT MAKES EVERYTHING WORSE.

STRESS CAN ALWAYS BE A FACTOR AND STRESS DID CAUSE G.I.

PROBLEMS.

I THINK EVERYBODY INTRINSICALLY KNOWS THAT.

BUT MOST OF THE PEOPLE THAT WE SEE HAVE AND UNDERLYING PHYSIOLOGIC PROBLEM.

THEY'RE STRESSED BY THE FACT THAT THEY'RE SICK AND THEN THEY'RE TOLD THAT THIS IS ALL DUE TO STRESS, WHICH IT USUALLY ISN'T THERE IS USUALLY AN UNDERLYING MEDICAL PROBLEM.

>> WHAT ABOUT DIET?

>> DIET IS CRUCIAL.

WE DON'T UNDERSTAND A LOT ABOUT DIET.

BUT IT'S ONE OF OUR PRIMARY TREATMENT MODALITIES 5 DS.

DIET IS NUMBER ONE.

PLAYS A BIG ROLE.

STOOL BIOME, WHICH IS A WHOLE OTHER CONVERSATION FOR YOU, STOOL BIOME IS CRUCIAL.

WE HAVE POUNDS OF ORGANISMS LIVING IN OUR G.I.

TRACT THAT IF THEY CAN GET OUT OF CONTROL, SORT OF LIKE CRAB GRASS GETS OUT OF CONTROL IN YOUR LAWN, YOU CAN GET INTO PROBLEMS.

MANY FACTORS GO INTO A NORMAL G.I.

FUNCTION.

>> WHERE DO YOU STAND ON FLUIDS THAT WE SHOULD BE DRINKING AND THE AMOUNT OF FIBER WE SHOULD BE TAKING IN A DAY?

>> THAT'S GREAT.

FOR FLUIDS, USUALLY I WOULD SAY GO BY YOUR THIRST AND OBVIOUSLY ENVIRONMENTAL IF IT'S HOT YOU NEED MORE FLUIDS AND YOU WANT TO TRY TO KEEP YOUR URINE, WHICH IS A PRETTY GOOD THE COLOR OF LEMONADE.

THAT'S A PRETTY GOOD GUIDE TO HOW WELL HYDRATED YOU ARE.

FIBER.

WE REALIZE THAT IN OUR WESTERN COUNTRIES WE DON'T GET AS MUCH FIBER AS WE SHOULD AND SO I RECOMMEND MOST PEOPLE TRY TO CONSCIOUSLY INCREASE FIBER IN THEIR DIET OR A FIBER SUPPLEMENT >> I WOULD LIKE TO TALK MORE ABOUT FUNCTIONAL DISORDERS ALONG THE LINES OF SOME OF THE DISRUPTIONS IN THE NERVE IMPULSES OR EVEN HORMONAL STIMULI OPPOSED TO MECHANICAL THINGS LIKE CANCERS OR TWISTED BOWEL IF THAT'S OKAY WITH YOU.

>> SURE.

OKAY.

SO WITH THAT IN MIND, WHAT ARE SOME OF THE THINGS THAT YOU WOULD DO TO EVALUATE SOMEONE WHO COMES IN TO SEE YOU?

IF THEY SAY LOOK, WHAT ARE THE COMPLAINTS THAT PEOPLE TYPICALLY HAVE?

>> SURE, WELL, IF YOU LOOK AT NATIONWIDE SURVEYS OF, LET'S SAY 71,000 PEOPLE, ABOUT 30% HAVE REFLUX AND HEART BURN PROBLEMS.

>> WHAT IS THAT.

>> REGURGITATION THAT MOST PEOPLE EXPERIENCE-- >> ARE THEY THROWING UP WITH THIS OR JUST HEART BURN?

>> USUALLY HEART BURN OR HEART BURN SYMPTOMS.

ABOUT 20% HAVE ABDOMINAL PAIN WHICH IS NOT UNCOMMON.

ANOTHER 15 TO 20% HAVE CONSTIPATION, DIFFICULTY MOVING THEIR BOWELS.

>> HOW DO YOU DEFINE CONSTIPATION.

YOU TOLD BUS STOOL PATTERNS ALREADY.

>> DIFFICULTY IN MOVING BOWELS.

>> DIFFICULTY.

>> WHERE IT'S A PROBLEM.

>> ABOUT 10% OF THE PEOPLE HAVE NAUSEA VOMITING, 9.5% OF THE POPULATION HAVE NAUSEA VOMITING AND 5% HAVE INCONTINENCE, FECAL INCONTINENCE LIKE URINARY INCONTINENCE.

COMMON PROBLEMS.

THESE ARE DISORDERS THAT AFFECT MILLIONS OF PEOPLE.

>> WE TEND TO SEE SOME DISEASES THAT HAVE SOME MANIFESTATIONS IN THE-- OR CAUSE PROBLEMS IN THE GASTROINTESTINAL TRACT.

TELL ME ABOUT DIABETES.

>> I'M GLAD YOU MENTIONED THAT.

BECAUSE WHEN YOU COME IN, WE TRY TO SEE WHAT OTHER MEDICAL PROBLEMS SOMEONE MIGHT HAVE.

AND DIABETES IS NOW AN INCREASING NUMBER OF PEOPLE IN THE WORLD HAVE TROUBLE WITH GLUCOSE CONTROL AND OFTEN TIMES DIABETES.

ONE OF THE MANIFESTATIONS OF DIABETES IS NEUROPATHY THAT CAN AFFECT THE AUTONOMIC NERVES AND ENTERIC NERVES.

PROBABLY THE SINGLE MOST COMMON THING YOU SEE, NOT THE MAJORITY OF PATIENTS BUT IT'S STILL THE SINGLE MOST COMMON THING WE RECOGNIZE.

BUT THERE ARE LOTS OF OTHER CAUSES OF NEUROPATHY, FOR EXAMPLE, AMYLOID, WE TALKED ABOUT THE OTHER DAY, ANYTHING THAT AFFECT NERVE AND MUSCLE AND PARKINSONS.

MOST PEOPLE ARE AWARE OF PARKINSON'S AND MOVEMENT PROBLEMS.

ANY OF THOSE CAN AFFECT THE G.I.

TRACT.

>> BACK WHEN I WAS IN MEDICAL SCHOOL WITH GALEN, VERY EARLY ON, WE USED TO TALK ABOUT HYPOTHYROID, LOW THYROID LEVELS.

DO WE STILL SEE THAT AS A PROBLEM WITH G.I.

>> ALL ENDOCRIN PROBLEMS.

ELECTRICAL ACTIVITIES DIRECTLY RELATED TO THYROID FUNCTION SO YOU SEE HYPOAS AS WELL AS HYPER.

LOW OR HIGH.

>> WHAT TEST DO YOU USE TO EVALUATE A PERSON.

>> IT HAS EVOLVED.

WHEN I WAS IN TRAINING 50 YEARS AGO, WE USED BARIUM STUDIES, HAVE SOMEBODY COME IN FASTING.

THAT HAS BEEN LARGELY BUT NOT TOTALLY REPLACED BY ENDOSCOPIES, UPPER AND COLONOSCOPY AND SMALL VOWEL.

WE USE A LOT OF RADIO NUCLEI AND WE TAKE FOOD AND RADIO LABEL IT.

GASTRIC TEST, DOLL ONTIC TRANSIT.

WE DO INCREASINGLY.

NON-INVASIVE TESTS THE ONE I'M INVOLVED IN RIGHT NOW IS BODY SURFACE MAPPING, AN EKG OF YOUR STOMACH.

BUT WE USE 66 ELECTRODES.

>> 66.

>> ON THE ABDOMEN AND YOU CAN LOOK AT STOMACH AND LOOK AT COLON THAT WAY.

>> YOU CAN MEASURE HOW THINGS ARE MOVING THROUGH.

>> ELECTRICAL ACTIVITY?

>> RIGHT.

BUT IF YOU READ ABOUT THE HISTORY OF MEDICINE, A LOT OF THE LAST 120 TO 140 YEARS IS RELATED TO THE REDISCOVERY OF ELECTRICAL ACTIVITY.

>> YOU ARE GOING TO FORCE ME INTO THIS BECAUSE BEFORE WE TALK ABOUT SOME OF THE TYPICAL THINGS, THERE IS THIS NEW CONCEPT OF, I GUESS PEEP CALL IT ELECTROSUED CALS.

WE HAVE PHARMACEUTICALS THAT ARE DRUGS BUT THERE IS A WAY OF LOOKING AT ELECTRICITY AS A MEANS TO TREAT PEOPLE.

EXPLAIN THIS TO ME.

>> MAYBE TALK A LITTLE BIT LATER ELECTRICAL STIMULATION.

>> PLEASE ANY TIME YOU WANT.

>> I CAN TALK RIGHT NOW ABOUT THAT.

SO ONE OF THE THINGS I HAVE BEEN INVOLVED WITH THE LAST THREE OR FOUR YEARS IS ELECTRICAL STIMULATION SO CALLED PACE MAKER FOR THE G.I.

TRACT.

>> SO LIKE WE HAVE FOR THE HEART.

YOU ARE TALKING ABOUT FOR THE G.I.

TRACT.

>> SAME DEVICE USED IN SPINAL CHORD USED IN PARKINSON'S DISEASE AND STIMULATION, SO IT'S THE SAME DEVICE AND IT HELPS A LOT OF PATIENTS.

IN FACT WE DO IT ENDOSCOPICALLY AS WELL.

ONE OF THE FEW CENTERS THAT DOES IT THAT WAY.

BUT IT'S BEEN REALIZED THAT YOU CAN ACTUALLY DEVELOP AN ELECTRICAL SIGNALS THAT CAN BE DISPENSED THROUGH A PILL.

SO THAT'S THE WHOLE IDEA WITH ELECTROSEUTICALS.

I THINK THAT WILL HAPPEN.

THERE IS ALREADY A PILL-- >> A PILL.

>> THAT STIMULATES THE COLON.

>> THERE IS A PILL THAT STIMULATES THE COLON.

I THINK WE WILL SEE THAT FOR OTHER G.I.

CONDITIONS.

THEY'RE IN CLINICAL TRIALS.

>> SO ARE YOU SO MUCH AS STIMULATING THE NERVE OR ARE YOU STIMULATING-- YOU MENTIONED THERE ARE THESE CHANNELS.

ION CHANNELS.

ARE WE STIMULATING THOSE THINGS TO ALLOW CHEMICALS TO CAUSE THE CONTRACTION?

>> THAT'S ULTIMATELY WHAT HAPPENS AND THERE ARE OTHER PATIENTS THAT WE SEE THAT HAVE THESE CHANNELS AND ANTIBODIES AND WE SOMETIMES USE IMMUNOTHERAPY TO TREAT THAT.

THAT'S ANOTHER THERAPY THAT WE USE.

WE SOMETIMES USE ENDOSCOPIC AND SURGICAL THERAPIES TO DISRUPT SFEENGTERS THAT ARE TOO TIGHT THESE ARE THINGS WE USE A LOT BESIDE DIET AND DRUGS.

WE USE, THE OTHER DS.

WOULD BE DISRUPTION AND DETOXIFICATION.

AND DEVICES.

DEVICES I MENTIONED.

>> BUT TELL ME-- I WANT TO SPEND A COUPLE MORE MINCE WITH THE ELECTROSEUTICAL THING.

IT IS FASCINATING.

LIKE A PACE MAKER.

STIMULATING THE GASTROINTESTINAL TRACT.

DOES THE PERSON HAVE TO TURN IT ON?

I EAT, IT AUTOMATICALLY SAYS YOU HAVE EATEN AND WE ARE GOING CAUSE CONTRACTION?

HOW DOES THAT WORK?

>> IT'S EARLY DAYS.

IT'S LIKE THE EARLY DAYS OF AUTOMOBILES WHEN YOU LOOK BACK IN 1910 AND 1920.

PEOPLE WERE TRYING ALL KINDS OF THINGS.

A LOT OF THINGS ARE BEING TRIED RIGHT NOW.

SOME OF THEM ARE ON ALL THE TIME , ELECTRICALLY ON.

OTHERS ARE DESIGNED TO BE TURNED ON IN RESPONSE TO FOOD, FOR EXAMPLE.

OTHER DEVICES ARE USED.

THERE IS A STIMULATION THAT GOES IN THE LEFT EAR THAT STIMULATES AND SOME OF THESE ARE USED FOR OTHER DISORDERS LIKE VAGAL STIMULATION.

WELL ESTABLISHED THERAPY.

SO PART WHAT HAVE WE TREAT RIGHT NOW WITH PATIENTS IS VAGAL STIMULATION OF THE G.I.

TRACT.

SO I THINK IT IS AN EXCITING TIME TO BE WORKING IN THIS AREA AND I HAVE BEEN FORTUNATE TO CONTINUE TO WORK AND RESEARCH WITH OUR FRIENDS HERE IN KENTUCKY AS WELL AS NATIONAL INSTITUTE OF HEALTH.

>> SO LET'S-- I'M GOING TO ASSUME THAT THE USE OF ELECTRICITY IS NOT THE FIRST LINE OF THERAPY THAT WE GO TO.

>> NO.

>> TELL ME.

TAKE ME THROUGH THE STEPS.

YOU MENTIONED A FEW THINGS WHEN YOU TALKED ABOUT THE FIVE Ds, BUT TELL ME ABOUT THE STEPS YOU USE WHEN SOMEBODY COMES IN WITH DISPOE TILT PROBLEMS.

>> FIRST WE ARE TRYING TO SEE THEM AND SEE IF THEY HAVE AN UNDERLYING PROBLEM AND DISCOVER THAT MIGHT EXPLAIN LIKE DIABETES OR THYROID PROBLEMS, OTHER PROBLEMS.

AND WE ARE TRYING TO SEE IF IT IS A PROBLEM GOING TOO FAST OR TOO SLOW BECAUSE SOME PEOPLE EMPTY TOO FAST FROM THEIR STOMACH OR SMALL BOWEL OR COLON.

AND THEN WE THEN WE DO SOMETHING MINIMALLY INVASIVE.

ENDOSCOTCH-- ENDOSCOPICALLY, THEN BLOOD TESTS FOR NERVE AND MUSCLE.

MAY DO ENDOSCOPIC MATERIALS WHERE WE MEASURE THE PRESSURE IN THE SPHINCTER.

SO LOTS OF SERIES OF TESTS TO FIGURE OUT WHERE THE PROBLEM IS BUT MOST IMPORTANTLY FOR THE PATIENTS IS TO TRY TO TREAT THEM AND WE USE COMBINATIONS OF THINGS.

AS I MENTIONED, DIET IS CRUCIAL.

WE USE SOME DEVICES AND SOME SPHINCTER DISRUPTIONS.

DETOXIFICATION OF THE ANTIBODIES AND THERE ARE OTHER THERAPIES AS WELL.

BUT BY THE TIME WE SEE PATIENTS, THEY HAVE USUALLY GONE TO THEIR PRIMARY CARE DOCTOR EXPERTS IN COMMON DISEASES.

THEY GO TO OTHER GASTROENTEROLOGIST OR OTHER SURGEONS AND THEN THEY COME TO US WHERE WE HAVE A WHOLE TEAM THAT TRIES TO EVALUATE PEOPLE IN THE SYSTEMATIC WAY.

AND WE CONTINUE TO WORK WITH THE PRIMARY CARE DOCS BECAUSE THAT'S THE BASIS OF OUR-- >> WHAT ARE SOME OF THE TYPICAL MEDICATIONS YOU MAY START OFF FRONT LINE, YOU OR THE PRIMARY CARE PHYSICIAN WHO MAY REFER SOMEBODY TO YOU.

WHAT ARE SOME OF THE MEDICATIONS THEY WOULD USE?

I KNOW, I IMAGINE IF SOMEBODY IS HAVING A LOOT OF DIARRHEA, YOU ARE GOING TO GIVE THEM SOMETHING TO CONSTIPATE THEM.

IS THERE SOMETHING TO MAKE THEM GO?

>> WE USE DRUGS TO SLOW DOWN DISORDER MOTILITY.

THERE ARE NOT A LOT OF DRUGS FOR INCREASING MOTILITY.

THERE IS ONE DRUG THAT HAS BEEN AROUND FOR 50 YEARS.

IT HAS A LOT OF SIDE EFFECTS SUCH THAT IT'S NOT RECOMMENDED FOR MORE THAN THREE MONTHS.

SO FOR A CHRONIC PROBLEM, IT'S NOT IDEAL AND WE ARE TRYING TO WORK HARD WITH THE FOOD AND DRUG ADMINISTRATION TO GET OTHER DRUGS APPROVED; SO WE OFTEN TIMES USE A LOT OF PROTON PUMP INHIBITORS BECAUSE SOME PEOPLE WITH REFLUX BENEFIT GREATLY FROM THOSE AND OTHERS WITH DISPEPSIA.

PAIN AFTER EATING BENEFIT FROM THOSE.

SOME OF OUR PEOPLE HAVE SICK LIKE EPISODES WHICH IS A MIGRAINE EQUIVALENT, SICK LIKE VOMITING.

THAT'S A WHOLE OTHER TALK.

PEOPLE WHO GET SICK TWO OR THREE DAYS A MONTH AND THEN PRETTY MUCH WELL IN BETWEEN.

AND ONE OF THE FIRST LINES FOR THAT IS PROTON PUMP INHIBITORS BUT THEN WE USE VARIOUS MIGRAINE-LIKE DRUGS TO TREAT THEM.

AUTONOMIC AND CENTRAL DRUGS.

WE HAVE LOTS OF OTHER MEDICATIONS, EITHER TO INCREASE MOTILITY FOR CONSTIPATION.

MOST OF THOSE WORK JUST ON THE COLON.

USUALLY A BLOTTER.

BUT SOME OF THE DRUGS WORK WITH THE WHOLE G.I.

TRACT WHICH CAN BE HELPFUL FOR SOME OF OUR PATIENTS.

SO ONE OF THE KEYS FOR US IS GOOD HISTORY, PHYSICAL EXAM AND TRYING TO SORT OUT WHAT IS WRONG OR MAYBE MORE THAN ONE AREA, AND THEN TRY TO GET A THERAPY THAT IS GOING TO WORK THAT THE PATIENT CAN GO BACK TO THEIR PRIMARY CARE DOC, CONTACT AS NEEDED AND WE CAN SEE THEM AS WE NEED TO.

BUT THESE ARE COMMON DISORDERS, EVEN THE PROBLEMS WITH DELAYED EMPTYING IS CLOSE TO 2% OF THE POPULATION.

>> 2%.

>> YEAH SO THAT MEANS IN KENTUCKIANA THERE IS PROBABLY ABOUT 100,000 PEOPLE WITH GASTROPERISIS.

>> WHEN YOU ARE TALKING ABOUT CYCLIC VERSUS NON-CYCLIC VOMITING, IT REMINDS ME OF THE PATIENT WITH IRRITABLE BOWEL SYNDROME.

A LOT OF DIARRHEA, CONCITY CONSTIPATION: IS THAT A PREDICTOR DOWN THE ROAD.

>> THAT IS A GOOD QUESTION.

IRRITABLE BOWEL SYNDROME IS VERY COMMON AND HAS TWO MANIFESTATIONS.

ONE IS DIARRHEA AND ONE IS CONSTIPATION PREDOMINANT.

IN THE PAST WE DIDN'T HAVE GOOD TREATMENT FOR THAT.

WE REALIZE SOME PEOPLE ARE VERY SENSITIVE TO THE FOOD THEY EAT AND THERE ARE SPECIFIC FOODS THAT CAN BE AVOIDED THAT HELP IRRITABLE BOWEL SYNDROME.

THERE ARE NOW A NUMBER OF MEDICATIONS FOR IRRITABLE BOWEL SYNDROME, SOME OF WHICH ARE WORK VERY WELL.

SOME OF THEM ARE RELATED TO THE MEDICATIONS WE USE FOR CONSTIPATION.

SOMETIMES IT'S THE SAME MEDICINE.

BUT IT'S A VERY IMPORTANT AREA AND COMMONLY SEEN IN PRIMARY CARE PARTICULARLY.

ALSO BY US.

>> WITH ABOUT A MINUTE LEFT, WHAT ARE THE BIGGEST TAKE HOME POINTS YOU WANT US TO KNOW ABOUT MOTILITY?

>> WELL, FIRST IF PEOPLE ARE HAVING SYMPTOMS, THEY SHOULD SEE THEIR PRIMARY CARE DOC BECAUSE PRIMARY CARE DOCS ARE EXPERTS AT COMMON DISEASES AND SECONDLY TO REALIZE THAT IF THEY'RE NOT ABLE TO BE HELPED, THEY WILL PROBABLY BE REFERRED ON.

BUT THAT WE DO HAVE CLINICS LIKE OUR ONE HERE IN KENTUCKY THAT TRIES TO SEVEN THE WHOLE AREA.

AND THAT THERE ARE NEW DIAGNOSTIC TECHNIQUES AND TREATMENT TECHNIQUES.

I THINK THE FUTURE IS FULL OF A LOT OF OTHER OPTIONS.

>> WHAT ABOUT LIFESTYLE CHANGES?

WE DIDN'T SAY A LOT ABOUT THAT.

>> OBVIOUSLY IMPORTANT.

DIET, EXERCISE, SLEEP.

ALL THESE THINGS.

SLEEP DISORDERS, SLEEP APNEA HAS A LOT OF G.I.

MANIFESTATIONS AS WELL.

VERY IMPORTANT, THE NEW DRUGS WE MENTIONED EARLIER, THE GLP DRUGS ARE VERY LIFE SAVING FOR-- LIFE CHANGE AND PERHAPS LIFE SAVING FOR SOME PEOPLE.

SO IT'S A WHOLE NEW WORLD.

>> GETTING HARDER OR EASIER FOR YOU?

>> HOPEFULLY EASIER, I HOPE.

>> WELL, I MUST ADMIT, I'M ANXIOUS TO SEE WHAT COMES OUT WITH ELECTRICAL STIMULATION.

THAT JUST SOUNDS UTTERLY, UTTERLY FASCINATING.

AND SO WE MIGHT HAVE TO HAVE YOU COME BACK LATER ON AND HAVE YOU PLUG US IN SO WE CAN GET GOOD BOWEL MOVEMENTS.

THANK YOU VERY MUCH FOR BEING WITH US AGAIN.

REALLY APPRECIATE IT.

THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF THE NORMAL FUNCTION.

G.I.

TRACT AND THE THINGS THAT LEAD TO DYSFUNCTION.

FOR THOSE WITH DISMOTILITY ISSUES OR IF YOU KNOW SOMEONE WITH DISMOTILITY COMPLAINTS, THERE ARE MANY GOOD TREATMENTS AVAILABLE AND SOME FASCINATING OPTIONS THAT YOU HEARD ABOUT COMING DOWN THE PIPELINE.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE ABOUT TO WWW.KET.ORG/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KY HEALTH OTT KET.ORG.

I LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH.

IN THE MEANTIME, LOOK AT WHAT YOU ARE EATING, PAY ATTENTION TO HOW OFTEN YOU ARE HAVING BOWEL MOVEMENTS AND FIND OUT WHAT IS NORMAL-FOR-YOU AND IF YOU HAVE ANY QUESTIONS OR CONCERNS, DO TALK TO YOUR PRIMARY CARE PHYSICIAN BECAUSE THINGS CAN BE DONE OR WE NEED TO FIND OUT WHY YOU ARE HAVING TROUBLE.

SEE NEXT TIME.

>> KENTUCKY HEALTH IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.