Inside Tract
November 28, 2014

Motility difficulties can be maddening hard to pin down. Often, symptoms that manifest as gut troubles are actually signs of illness somewhere else.

The new Johns Hopkins Center for Neurogastroenterology brings together experts from diverse fields and specialties, united in their goal of solving motility mysteries.

Is a patient’s nausea related to gastric issues? Or are the symptoms the result of an allergy? Is her reflux caused by GI problems? Or could it be the work of a rheumatic disease?

When symptoms overlap specialties, patients can get lost in a maze of appointments, testing and crossed signals.

“In many ways, neurogastroenterology represents one of the last and most exciting frontiers in medicine,” says center director Jay Pasricha. “The enteric nervous system, the brain inside our gut, is increasingly being recognized as a key player not only for digestive disorders, but also for metabolic conditions, such as obesity and diabetes, as well as anxiety and depression.”

Pasricha’s colleague John Clarke estimates that two-thirds of the patients he sees in his GI-only clinic come to him with problems that present few obvious clues. Abdominal pain, nausea and constipation are serious enough to make life unpleasant for patients but often don’t offer solutions via endoscopy or imaging.

“For most patients with what we call ‘functional GI disorders,’ nothing’s going to leap out of the endoscopy that says ‘here’s the problem,’” Clarke says. “Our center is designed to deal with problems we can’t solve with endoscopy or imaging alone.”

Pasricha, Clarke and their colleagues at the Center for Neurogastroenterology collaborate with handpicked members of other Johns Hopkins divisions on each patient the center sees. Patients with hard-to-diagnose problems get care that’s customized precisely to their symptoms.

“We look for connecting threads in our patients and try and provide a comprehensive approach to their problems, along with our colleagues in related disciplines,” Pasricha says.

“Our patients see GI doctors, but also allergists, nutritionists and doctors from divisions like pathology, surgery, psychiatry and gynecology,” says Clarke. “We bring a lot of resources to the center, a lot of really accomplished doctors at the top of their games.”

The center is more versatile than most, Clarke says. If they prefer, doctors from outside Johns Hopkins can send patients for testing only, then continue to see the patients at their own practices.

“The range of tests we can do is pretty extensive,” says Clarke. “Esophageal manometry, breath testing to detect small intestine bacterial overgrowth, smart pills, electrogastrography. Our hope is really to offer every diagnostic test out there.”

Located at Johns Hopkins Bayview Medical Center, a few miles east of The Johns Hopkins Hospital, the Center for Neurogastroenterology opened in the summer of 2014. In only a few months, the six GI physicians, a nurse practitioner, several full-time clinical nurses, and numerous basic scientists and specialists from other fields have seen the center’s patient population boom.

“The downside is that there’s a waiting list for consultations,” says Clarke. “But not for testing. You can get testing right away.”

Clarke says patients with gastric symptoms are often desperate for relief.

“They’re coming in with unexplained symptoms, and they want to feel better. By getting the different practitioners involved, I think it gives more of a multi-disciplinary approach that looks at the whole person, instead of one system specifically.”