Richard W. McCallum, MD FACP, FRACP (AUST), FACG, AGAF, Professor of Medicine and Founding Chair, Department of Internal Medicine, Director, Center for Neurogastroenterology and GI Motility, El Paso, TX
Hello colleagues. I certainly hope the first six contributions in this series, The Clinical Spectrum of Gastrointestinal Motility and Functional Bowel Disorders for the Practitioner, have enhanced your knowledge base, improved the care provided by us and our staff in our practice and given us confidence that we are gaining the credentials to warrant the term “Card Carrying Motility and Functional Gut Expert”. Armed with this new knowledge let’s expand our horizons even further.
Next, we will reach out to our Pediatric Gastroenterology colleagues, who sometimes can feel a little neglected since they are not being specifically catered to by adult GI articles. We address this deficiency with two articles: The first, “Pediatric Biliary Dyskinesia and Sphincter of Oddi Dysfunction” and the second, “Update in Pediatric Gastroparesis”. These cover a large spectrum of GI issues in children and we will continue to re-visit pediatric GI in future articles.
We then turn our attention to “late breaking news”. Since it is an entertainment term, like the Brian Williams saga in the television world, much news can be overstated. Such is the case with Domperidone and the “Doom and Gloom” over less than well-founded and documented statements on cardiac toxicity that I see bandied around. We review this agent in great detail and conclude that it remains the “champagne” of the antiemetic/prokinetic world. We strongly endorse its efficacy and safety and recommend much broader use in your practices.
We then turn our attention to a series of three articles covering the topics of “Gas and Bloating” — “Integrative Medicine” and wait for it…”Herbal Medicine” where we will provide clinical pearls. Sometimes referred to as the “scourge” of our practice, gas and bloating of undetermined origin has a rational algorithm of diagnosis and treatment, the former relying on the judicious use of glucose and fructose breath testing and the latter on knowledge of treating small bowel bacterial overgrowth, utilizing low fructose, FODMAP diets, and food allergy concepts. Here we are under the expert guidance of second year GI Fellow, Dr. Juan Castro.
We then turn to integrative and holistic medicine with one of my GI Fellows, Dr. Christine Yu, who found time in her second year of GI Fellowship to do online training and certification in this field. Balance is the key – apparently to everything – but definitely in regard to brain / gut balance. The challenge is how to integrate “old world” wisdom with new world technology and actually surprise our patients with “old school” genuine patient involvement. Combined with this article I have asked one of my colleagues, a unique individual with a Ph.D in herbal medicine, Dr. Armando Gonzales – Stuart, to teach us how herbal medicines are not “bad news” based on concerns for liver and other toxicity, but actually have a host of great things to offer our patients.
Here at Texas Tech El Paso, on the border with Mexico we appreciate the rich Hispanic heritage and culture. The common use of food supplements in Hispanic families reminded me of the benefits of this approach when balanced with the patients’ own unique personal medical diagnoses and ways to complement our prescription medications for symptoms. Now we can all learn about this aspect of over the counter use for relief of symptoms in our patients.
The Paul L Foster School of Medicine is flourishing here at Texas Tech, El Paso. We graduate our second medical school class in May, at the same time as I am presenting you our second installment of this series.
A final word. I plan to see that great rock band The Eagles in El Paso. Remember the line from their song Hotel California: “you can check out any time you like, but you can never leave”. So you are now committed. Please stay in the classroom of GI Motility and Functional Bowel Disorders with the University of Practical Gastroenterology.