Training in Motility & Functional Disorders

Trainees will be exposed to these disorders during both inpatient and outpatient services and will follow these patients from months to years. They will acquire skill to develop a management plan and coordinate the management of patients with different experts.

In addition to direct exposure to these disorders, didactic lectures on the pathophysiology and clinical treatment of children with functional gastrointestinal disorders and common gastrointestinal motility disorders will be available through grand rounds and postgraduate courses.

Trainees will participate and/or observe the following procedures under supervision: videofluorosocopic studies of swallowing, esophageal manometry, radionuclide gastric emptying studies, antroduodenal motility studies, radiopaque marker colonic transit studies, anorectal manometry, and anorectal biofeedback.

At the end of basic training period trainees will be able to:

• Recognize the manometric features of major motor disorders of the esophagus and anal sphincter
• Know the indications, dosage, and side effects of medications used commonly to treat motility disorders
• Become competent in performing esophageal pH probe tests and interpreting the results
• Perform rectal biopsies adequate for the diagnosis of Hirschsprung disease with an appropriate mentor providing instruction and guidance
• Interpret radiographs and radiographic contrast studies
• Select and interpret appropriate diagnostic tests
• Understand the indications, limitations, technical aspects, and complications of the relevant procedures
• Generate a differential diagnosis, formulate a therapeutic plan
• Coordinate the management of patients with different experts

Trainees should maintain a documented log of appropriate numbers of the types of studies they conduct and interpret while supervised by an appropriate mentor.

The Level 1 competence requires the performance of the following number of procedures during the 3-year training period:

Esophageal pH monitoring	20
Rectal biopsy to rule out Hirschsprung disease	10