Neuro-gastroenterology: Advanced Functional Gastro-Intestinal Diseases (ICMM936/944)

At the end of this module, students should be able to:

1. Explain the brain-gut axis communication, the neural pathways involved and the type of information that is encoded by each pathway.
2. Explain the relationship between intestinal microbiota and the immune system with the central nervous system.
3. Identify hormones, neurotransmitters and receptors that mediate GI functions.
4. Recognise neurophysiological techniques that can be used to study gut sensation.
5. Identify metabolic and systemic conditions that can affect sensory and motor functions of the GI tract.
6. Outline the differences in the presentation of visceral pain compared to somatic pain. Describe the functional anatomy of visceral pain processing and how this correlates to the key features of visceral pain. Understand the concept of visceral hypersensitivity, hyperalgesia, allodynia and appreciate the contribution of peripheral sensitisation (PS) and central sensitisation (CS) to these states. Be able to give examples of molecular mediators and how they participate in PS.
7. Understand that there are different classes of anti-emetic drugs with different sites of action. Appreciate that nausea is not the same as vomiting. Know the main drugs used to treat gastroparesis.
8. Understand that the gastrointestinal tract is the largest endocrine organ in the body. Appreciate that different gastrointestinal hormones are released during hunger and after eating and that they have different main roles.
9. Describe the different mechanisms involved in the pathophysiology of gastro-oesophageal reflux disease (GORD). Explain the differences between erosive reflux  disease, non-erosive reflux disease and functional heartburn. Know current and developing treatment of GORD.
10. Describe the properties of the oesophageal epithelium that protect against reflux damage. Discuss the evidence implying that changes in mucosal integrity occur in non-erosive reflux.
11. Know the principles and indications of GI physiology techniques: standard oesophageal manometry, oesophageal high resolution manometry, impedance testing, oesophageal pH monitoring, bilitec, gastric emptying studies and small bowel manometry.
12. Recognise functional GI disorders causing diarrhoea and differential diagnosis. Describe the diagnosis, management approach and treatment options of small bacterial overgrowth.
13. Define chronic constipation and chronic intestinal pseudo-obstruction and recognised investigations used in the diagnosis of these disorders. Understand that there are different classes of laxative drugs. Know current treatment of constipation.
14. Define Sphincter of Oddi function and dysfunction and its management.
15. Define Hirschsprung disease and anorectal malformations.
16. Understand psychological aspects of functional gastro-oesophageal disorders and the modulation of visceral pain by psychological factors.

One examination lasting 1 hour. This module exam is worth 60% of the mark for the module, with the remaining 40% constituted by coursework, which will be set at the start of the module. The coursework assignment [essay] will have a maximum of 2000 words, or an oral presentation or a poster presentation to the examiner.