Organizing and Developing a GI Motility Lab in Community Practice: Challenges and Rewards.
Organizing and Developing a GI Motility Lab in Community Practice: Challenges and Rewards.
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在社区实践中组织和发展胃肠动力实验室：挑战和奖励。
DOI：
10.1007/s11894-022-00838-5
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发表时间：
2022
影响因子：
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通讯作者：
Rao,SatishSC
中科院分区：
文献类型：
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作者：
Baker,JasonR;Curtin,BryanF;Moshiree,Baharak;Rao,SatishSC
综述目的神经胃肠病学和运动学是一个快速发展的亚专业，涵盖超过 33% 的胃肠病学疾病，以及高达 50% 的胃肠病学实践转诊。它包括吞咽困难、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、胀气/腹胀、小肠细菌过度生长、食物不耐受和大便失禁等常见问题。内窥镜检查或影像学等标准诊断测试在这些情况下是正常的。为了确定这些疾病的潜在机制/病因，通常需要进行诊断性运动测试。这些最好由训练有素的人员在专门的运动实验室中执行。我们的目的是根据我们在学术界和社区实践中建立此类设施的集体经验，提供关于如何组织和发展动力实验室的最新概述。最新发现缺乏提供诊断动力测试的知识、培训和设施导致患者护理不理想。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）、肛门直肠功能测试（如肛门直肠测压）、神经生理学和球囊排出、菌群失调和食物不耐受测试（如氢气/甲烷呼气测试）以及胃肠道转运评估。这些测试提供准确的诊断并指导临床管理，包括药物的使用、生物反馈疗法、神经调节、行为疗法、循证饮食干预以及内窥镜或外科手术。此外，最近在运动程序的计费和编码以及培训要求方面取得了一些进展，但这些进展并不为人所知。摘要本综述提供了如何在社区或学术实践中建立运动实验室的逐步方法，包括基本原理、基础设施、人员需求、常用的运动测试及其临床效用、计费和编码策略、培训需求和建立这项服务的经济考虑。
Purpose of ReviewNeurogastroenterology 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 FindingsA 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.SummaryThis 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.