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GI Motility Research Laboratory

Gastrointestinal disorders, dysphagia, constipation, faecal incontinence...

 

Research Summary

Functional gastrointestinal disorders (FGID) include abdominal pain, dysphagia (difficulty in swallowing), irritable bowel syndrome, diarrhoea and constipation. These chronic conditions induce major economic and social burdens because of their prevalence in society and their dramatic impact upon quality of life. Our GI motility research laboratory is at the forefront of the development of novel objective methods to assess swallowing and colonic disorders and their pathophysiology. Using state-of-the-art recording techniques of high-resolution impedance manometry and high-resolution fibre-optic manometry our methods quantify pressure and diameter profiles recorded within the gut and employ innovative analytical software to unlock a wealth of physiologically relevant information. These data highlight structural abnormalities, dysfunctions of neuro-sensory, and/or neuro-motor mechanisms. The accurate diagnosis of the pathophysiology in the pharynx, oesophagus or colon is critical to providing timely and appropriate treatments for FGID.

 

Upper GI - Taher Omari

 

Lower GI - Phil Dinning

Research Projects

Mechanical impacts of colonic dysmotility in patients with functional colonic disorders
Faecal incontinence, constipation and irritable bowel syndrome cause significant medical, societal and financial burdens. Altered colonic motility is implicated and these changes contributes to the troubling, distressful and at times embarrassing symptoms. Through state-of-the-art techniques, developed by our group, our research combines human and animal studies to provide the first clear description of colonic contractile abnormalities in these patients and how they contribute to the symptoms.

Oro-pharyngeal dysphagia is a commonly encountered co-morbidity of any disease or condition that affects the neural control and/or contractility of muscles of the head and neck or alters oro-pharyngeal anatomy. There is a need for our understanding of paediatric dysphagia to be grounded in detailed knowledge of swallowing biomechanics, physiology and pathophysiology. This ‘value-adding’ information will be critically important for generating sound hypotheses for clinical trials of tailored interventions. This project will establish a new point-of-care diagnostic paradigm-shift that elucidates dysphagia pathophysiology through the understanding of swallowing biomechanics. The project will have wide-ranging significance to paediatric dysphagia in terms of i) better understanding of pathophysiology, ii) better treatment outcomes through hypothesis-driven research, iii) improved quality of life through avoidance of unnecessary procedures and reduced reliance on long-term x-ray.

Dysphagia complicating acute stroke is common, infers a poorer outcome. It carries significant morbidity and mortality which is dictated in large part by dysphagia-related pulmonary aspiration. Existing techniques (bedside evaluation, MBS) lack accuracy in predicting aspiration-related complications and their sequelae; both in hospital and in the longer term. This project will determined whether objective biomechanical measures of pharyngeal swallowing can predict clinical outcomes in this population. The validation of a new technique as a predictor of poor short and long term outcome would profoundly influence management by impacting directly: a) feeding management and nutrition; b) decision making and cost implications of institution of non-oral feeding (eg PEG placement); c) follow up care and timing of PEG removal where appropriate.

Selected Publications

Dinning PG, Sia TC, Raghu S, Rosli RM, Kyloh M, Wattchow DA, Wiklendt L, Brookes SJ, Costa M, Spencer NJ (2016) High-resolution colonic motility recordings in vivo compared with ex vivo recordings after colectomy, in patients with slow transit constipation. Neurgastroenterology & Motility, 28(12):1824-1835

 

Doeltgen S, Omari TI, Savilampi J (2016) Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: Quantification by a novel pressure-impedance analysis. American Journal of Physiology-Gastrointestinal and Liver Physiology. 310(11):G1176-82.

 

Omari TI, Jones CA Ms, Hammer MJ, Cock C, Dinning PG, Wiklendt L, Costa MC, McCulloch TM (2016) Predicting the Activation States of the Muscles Governing Upper Esophageal Sphincter Relaxation and Opening. American Journal of Physiology-Gastrointestinal and Liver Physiology, 310(6):G359-66.

 

Leibbrandt RE, Dinning PG, Costa M, Cock C, Wiklendt L, Wang G, Tack J, van Beckevoort D, Rommel N, Omari TI (2016) Characterization of Esophageal Physiology Using Mechanical State Analysis. Frontiers in Systems Neuroscience, 10:10.

 

Vather R, O’Grady G, Cheng L, Arkwright J, Rowbotham D, Dinning PG, Bissett I (2016) Restoration of normal colonic motor patterns and meal responses after distal colorectal resections. British Journal of Surgery, 103:451-461.

 

Arkwright JW, Underhill ID, Dodds KN, Brookes SJH, Costa M, Spencer NJ & Dinning PG (2016) A composite fibre optic catheter for monitoring peristaltic transit of an intra-luminal bead. Journal of Biophotonics, 9(3):305-10.

 

Omari TI, Wiklendt L, Dinning P, Costa M, Rommel N, Cock C (2015) Upper esophageal sphincter mechanical states analysis: A novel methodology to describe UES relaxation and opening. Frontiers in Systems Neuroscience, 8:241.

 

Dinning PG, Wiklendt L, Maslen L, Patton V, Lewis H, Arkwright JW, Wattchow DA, Lubowski DZ, Costa M, Bampton PA (2015) Colonic motor abnormalities in slow transit constipation defined by high-resolution, fiber-optic manometry. Neurgastroenterology & Motility, 27(3):379-88.

 

Dinning PG, Hunt LM, Patton V, Zhang T, Szczesniak MM, Gebski V, Jones M, Stewart P. Lubowski DZ,  Cook IJ (2015) Treatment efficacy of sacral nerve stimulation in slow transit constipation: A randomized, 2-phased, double -blind, placebo-controlled, crossover study. American Journal of Gastroenterology, 110(5):733-40.

 

Dinning PG, Wiklendt L, Omari T, Arkwright JW, Spencer NJ, Brookes SJ, Costa M (2014) Neural mechanisms of peristalsis in the isolated rabbit colon: a neuromechanical loop hypothesis. Autonomic Neuroscience, 8:(Article 75).

 

Dinning PG, Wiklendt L, Maslen L, Gibbins I, Patton V, Arkwright JW, Lubowski DZ, O’Grady G, Bampton PA, Brookes SJ, Costa M (2014) Quantification of in vivo colonic motor patterns in healthy humans before and after a meal revealed by high-resolution fibre-optic manometry. Neurgastroenterology & Motility, 26(10):1442-1457.

 


Investigators

  • Taher Omari, PhD, BSc(Hon)

  • Phil Dinning, PhD, BSc(Hon)

Support Staff

  • Ann Schloithe, Technical Officer

Students

  • Charles Cook, PhD Student

  • Lara Ferris, PhD Student

  • Helen Dockrell, PhD Student

  • Reizal Mohd Rosli, PhD Student


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