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Johns Hopkins Bayview News - A Gut Reaction

Fall 2012

A Gut Reaction

By: Allison Eatough
Date: September 3, 2012

Johns Hopkins center provides relief for people suffering from gastrointestinal disorders

Drew Ginsberg, motility disorder patient, running on sidewalk with his dog
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Drew Ginsberg is feeling back to normal again and staying active.

When Drew Ginsberg traveled to China in December 2010, he expected to enjoy the food, experience the culture and spend time with his brother, who was living in Shanghai at the time. He did not expect to vomit continuously for three days straight.

“I thought it was food poisoning,” says Ginsberg, 28. “But within 36 hours, I felt fine.”

Thinking he had rebounded to his normal, healthy self, Ginsberg continued his trip. “I ate everything, drank everything, with no problems at all,” he says.

But within two days of returning to his Takoma Park, Maryland, home, Ginsberg began vomiting again. And this time, he had extreme stomach pain and discomfort around his ribs.

“It felt like I was being stabbed over and over again,” he says. “Nothing was able to go down, or once it went down, it was forced back up.”

Visits to the local emergency room, two hospitalizations and prescribed medications failed to alleviate his symptoms, and within a few weeks, the fit, 6-foot-tall kinesiology instructor dropped from 196 pounds to just under 150 pounds.

“My body was starting to shut down,” he says.

That’s when he turned to the Johns Hopkins Center for Neurogastroenterology and Gastrointestinal Motility Disorders for help. John Clarke, M.D., clinical director of gastrointestinal motility, found Ginsberg was suffering from post-infectious dysmotility, a severe disorder that can follow an infection of the stomach and intestines.

“Drew needed medical help, and he needed it fast,” Dr. Clarke says.

Fortunately for Ginsberg, post-infectious dysmotility is one of the many motility and neurogastroenterology disorders the center diagnoses and treats, Clarke says.

Motility disorders described

Motility disorders are disorders involving the movement of food through the digestive system. Some of the more well-known examples include gastroesophageal reflux disease (GERD), also known as acid reflux, irritable bowel syndrome, severe constipation and esophageal spasms. People of any age can be affected, and a majority will suffer at least one time in their lives from a motility disorder. Many of these conditions are first presented to the primary care physician, who may then refer the patient to a gastroenterologist for further diagnosis and testing. While not uncommon, these disorders are notoriously difficult to assess, says Pankaj Pasricha, M.D., director of the Division of Gastroenterology at Johns Hopkins Bayview.

Fortunately, the Center for Motility Disorders is home to highly-trained gastroenterologists who specialize in the disorders and state-of-the art testing techniques. “We take care of complex conditions that have been hard to diagnose and treat,” Dr. Pasricha says. “And we are a resource to both patients and doctors.”

The brain-gut connection

Within the world of motility disorders, there is neurogastroenterology–a field that examines how a patient’s central nervous system and gut are involved. “The gut has its own brain,” Dr. Pasricha says.

The gut’s brain is known as the Enteric Nervous System. It’s a collection of nerve cells that are within the wall of the gut, running between the esophagus and rectum. Just like the larger brain in human heads, the system sends and receives impulses throughout the stomach and intestines. It also responds to emotions. Research shows this system can affect moods ranging from happiness to depression.

More importantly for motility disorder patients, this system can impact how the gastrointestinal tract works. It regulates absorption, digestion and moving material from one end of the gut to the other. For example, many patients with irritable bowel syndrome experience diarrhea, constipation and passing mucus. Often, problems with the brain-gut signals can be the cause, Dr. Pasricha explains.

The gut has more nerve cells than the entire spinal cord. Ninety percent or more of the body’s serotonin and half of the body’s dopamine, both chemicals that relay signals from one area of the brain to another, lie in the gut. Because of this, Dr. Pasricha and fellow Hopkins experts are performing research to examine how the brain in the gut relates to the brain in the head. The team is discovering new drug targets as it tries to understand the molecular basis for common symptoms such as abdominal pain and nausea, Dr. Pasricha says. Research into the Enteric Nervous System’s stem cells also holds promise for regenerating areas where function has been permanently lost.

“There’s a big picture here beyond just disorders,” he says. “The nerves in the gut have lots of clinical and physiological implications.”

Testing and treatments

While motility disorders are often difficult to diagnose, there are tests available to determine the type of disorder and its severity.

The Johns Hopkins Center for Neurogastroenterology and Gastrointestinal Motility Disorders is one of only a few locations on the East Coast to offer many of these tests, including high-resolution esophageal manometry to measure the strength and function of the esophagus muscles, 24-hour esophageal pH monitoring to evaluate acid reflux disease, and anorectal manometry to evaluate constipation or fecal incontinence.

The center also takes a multidisciplinary approach when it comes to treatment. Depending on the disorder, treatment can include medication, dietary changes, psychological therapy and alternative medicine, says Dr. Pasricha. To ensure patients have the best treatment plan possible, center physicians work with internists, allergists, psychiatrists, psychologists and complementary specialists like acupuncturists.

For Ginsberg, a combination of anti-nausea, pain and acid-blocking medication, probiotics and acupuncture did the trick. Two weeks after visiting Clarke, Ginsberg could finally keep water and sports drinks down. Then rice cakes, and then smoothies. Now, more than 18 months after his initial illness, Ginsberg is starting to feel normal again. He’s even eating vegetables and meat again. “I don’t have as much energy as I used to,” he says. “But for the most part, I feel healthy.”

The discomfort is gone, and his weight is back up to 165 pounds.

“I’m hoping to gain another 10 pounds back, but I’m happy being in this range,” Ginsberg says.

He’s also happy he found Dr. Clarke.

“All along, I knew I should have gone to Hopkins,” Ginsberg says. “If it wasn’t for Dr. Clarke, I could have been in a lot of trouble. I would recommend him 100 percent.”

To make an appointment with a Johns Hopkins gastroentrologist, call 410-550-0790.