Link To YouTube Video “Management of Gastrointestinal Symptoms in Dysautonomia – Laura Pace, MD, PhD”

Posted on February 23, 2022 by Tom Wade MD

In this post, I link to and embed the YouTube video, Management of Gastrointestinal Symptoms in Dysautonomia – Laura Pace, MD, PhD. Jul 20, 2020. Dysautonomia International.

Dr. Laura Pace is a neurogastroenterologist from the University of Utah. She gave a great overview of gastrointestinal motility testing and how these tests may be helpful for people with dysautonomia who have gastrointestinal motility problems.

gastrointestinal adji clinic so I’m
03:18
gonna start with a couple definitions um
03:20
so you know what I’m talking about so
03:21
review of systems I’m sure you guys have
03:23
all filled these out extensively for
03:25
every physician you’ve ever seen but
03:26
just so you know it’s a description of
03:28
symptoms related to a particular body
03:30
system so it can be related to the
03:32
cardiac system the pulmonary system or
03:34
the gastrointestinal system and then
03:37
comorbid conditions these are other
03:39
diagnoses or conditions that one has and
03:42
so when I see a patient in clinic and I
03:46
just sort of want to remind you that not
03:48
everyone I see initially knows that they
03:50
have a disorder of the autonomic nervous
03:52
system sometimes this is me picking it
03:55
up and sending them for confirmatory
03:56
diagnosis but many of you that come to
03:59
see me actually know you have already
04:01
have this diagnosis but what I do is I
04:04
start with a detailed history and
04:06
physical examination so wait well beyond
04:09
just gastrointestinal symptoms usually I
04:11
want to start when you first got sick
04:13
the vast majority are my patients are
04:17
female and they’ve already been seen by
04:19
usually a huge number of physicians in a
04:22
bunch of different specialties they
04:25
typically report a constantly
04:26
as symptoms and I’m sure none of these
04:28
are unusual for you I mean we can start
04:30
at the top with brain fog headache dry
04:32
mouth dry eyes palpitations shortness of
04:36
breath and numerous gastrointestinal
04:38
symptoms they usually range from
04:40
difficulty swallowing to even just like
04:43
what we call global sensation that’s
04:45
that persistent feeling that something’s
04:47
stuck in your throat and you kind of
04:48
keep swallowing to try and clear it but
04:51
you don’t have like a true impaction
04:53
within the esophagus all the way to
04:56
abdominal pain nausea vomiting
04:58
constipation diarrhea or some alteration
05:01
in between and so historically within
05:05
the realm of gastroenterology and even
05:08
when I came through training the
05:10
inclination has been to diagnose people
05:12
who come in with this constellation of
05:14
symptoms with a functional disorder such
05:16
as irritable bowel syndrome and this is
05:20
completely incorrect so that terminology
05:22
describes a cluster of symptoms but does
05:25
not give you a diagnosis and does not
05:28
impart any understanding to it to what
05:30
the underlying pathophysiology of your
05:33
symptoms are so typically functional
05:37
gastrointestinal disorders are symptoms
05:39
that do not have an identifiable
05:40
structure or biochemical basis and
05:42
everybody pretty much agrees on that
05:44
however many of these disorders we’ve
05:46
actually been able to resolve and we
05:47
understand what the cause is the reason
05:51
I’m showing this slide is I actually
05:53
find it’s helpful when I talk to other
05:55
physicians who think that the patients
05:59
that I’m seeing have a psychiatric
06:02
illness and so the point that I make
06:06
with this if we look at the innervation
06:08
of the autonomic nervous system it
06:11
innervates just about everything and so
06:14
when something with the autonomic
06:15
nervous system goes awry it’s not
06:17
surprising that you have all these
06:19
symptoms and so if you look at the the
06:23
sympathetic branches and then the
06:25
parasympathetic branches these two
06:28
systems have different functions and I
06:30
know many of you are probably familiar
06:32
with this but the sympathetic nervous
06:34
system is your fight-or-flight so when
06:37
this system is overactive it shut
06:40
down digestion and so what we see in
06:42
individuals with an overactive component
06:44
of the sympathetic nervous system we see
06:47
a lot of delay in different regions of
06:50
the gastrointestinal tract a lot of
06:52
difficulty with eating and then with the
06:56
parasympathetic nervous system you can
06:59
see the opposite so you can see a lot of
07:01
really persistent diarrhea that we have
07:02
a difficult time managing but again the
07:05
autonomic nervous system is innervating
07:08
everything it’s not unusual for you to
07:10
have all these symptoms it’s not unusual
07:12
if your symptoms are exacerbated by
07:14
stress that again does not mean that you
07:16
have a psychiatric illness no matter
07:18
what your physicians tell you what I
07:22
don’t understand when I am seeing you
07:24
guys in clinic is does the
07:27
gastrointestinal dysfunction come first
07:29
or does the dissident Omiya come first
07:32
is essentially a chicken or egg problem
07:34
and so the thing that I struggle with is
07:37
in order to make your gastrointestinal
07:39
symptoms better do I have to treat your
07:41
dissident Omiya and if your dissident
07:44
Omiya gets better can I expect your
07:45
gastrointestinal symptoms to get better
07:47
and I think that is the case and so I
07:50
think there are specific things that I
07:52
can do as a gastroenterologist but then
07:54
there are other things where we actually
07:55
really have to address the underlying
07:57
dissident Omiya one of the other
08:00
problems is I feel like it’s really
08:02
important to understand what comorbid
08:05
conditions you actually have and I know
08:07
there’s some debate about this but I
08:09
think it’s important to know whether you
08:10
have an underlying connective tissue
08:12
disorder whether it be EDS or some other
08:14
whether you have presence of mast cell
08:17
activation syndrome or a metabolic
08:19
disorder or an autoimmune disorder
08:21
because all of this is going to change
08:23
how I approach the symptoms that we have
08:27
to address for you so I recommend a
08:31
thorough evaluation so that I can put
08:33
together an entire clinical picture and
08:35
sort of make better recommendations and
08:37
so what I’m going to go through here is
08:39
the evaluation that I have most of my
08:42
patients undertake and not it’s not in
08:44
any specific order
08:45
I just tried to organize it so maybe if
08:47
we talked about one topic it would
08:49
relate to the topic before so we’re
08:51
going to start with motility testing
08:53
um and just so we’re all on the same
08:56
page a couple definitions so motility
08:58
describes movement and so essentially
09:00
when we’re talking about it in reference
09:02
to the gastrointestinal tract we’re
09:03
talking about coordinated movements so
09:05
we’re talking about appropriate
09:07
contractions in one segment relaxation
09:09
in another segment and then that
09:11
sequential change throughout time so as
09:13
you go through the entire
09:14
gastrointestinal tract transit time is
09:17
in reference to the time it takes to
09:19
move through a segment so the time it
09:22
takes your stomach to empty the time it
09:24
takes food and things like that to move
09:26
through your small intestine the time it
09:28
takes things to move through your colon
09:30
and then manometry it’s a measurement of
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