Journal of Gastroenterology and Hepatology (2002) 17 (Suppl.) S1–S14 can be learnt from the patient. In the last decade, the ‘Delphic’ technique has been used to try and define combinations of symptoms in the belief, or hope, that specific symptom patterns correspond to specific underlying disorders. The ‘Rome criteria’ for the de- finition and diagnosis of functional gastrointestinal disorders have received much attention. Unfortunately, consensus of opinions by experts does not, per se, confer scientific validity. Evidence-based medicine requires not consensus, but evidence. We have reappraised the problem of classifying motor disorders by relying on what can be established by the detection of abnormal motor patterns, usually, but not invariably, associated with the altered movement of the contents of the digestive tube. In some, but not yet all, disorders, this approach is reinforced by identification of underlying pathological change in enteric innervation or musculature. While we remain aware that the asso- ciation between symptoms—the perception that drives patients to seek help—and motor abnormalities is not always clear, we have taken the view that objectively reproducible alterations in organ function provide a robust basis for taxonomy. Such problems are not unique to gastroenterology; as an example, the associa- tion between dyspnea and specific pulmonary pathol- ogies is not always clear, but dyspnea is a useful indication of abnormal respiratory function indicative of disease. Clinicians may feel dismayed that we have not elected to define two commonly used terms: ‘functional dys- INTRODUCTION Although gastrointestinal motor activity has been studied for more than a century, the identification of motor disorders in clinical practice still presents prob- lems. Over the last two decades, the conventional tax- onomy of motor disorders, even assuming that such a classification exists, has been challenged by the realiza- tion that disorders of neural control of motor activity are, or may be, accompanied by altered visceral sensa- tion. It is now accepted that symptoms of disordered function such as ‘spasm’, traditionally interpreted by patients and physicians alike as representing abnormal motor events, may be caused by the abnormal sensory representation of normal motor activity. The increasing substitution of the term ‘neurogastroenterology’ for ‘motility’ implies recognition that the motor activity of the gut is determined by its innervation and, even more important, that the gut has both a sensory and a motor innervation. When the nerves controlling the gut are damaged, the damage may affect both motor and sensory domains; even when it is confined to one domain, the altered function in that domain may induce alterations in the other domain. Reliance on symptoms as indicators of disease enti- ties has, with the advance of diagnostic technology, almost disappeared in many branches of medicine. But the motor activity of the digestive tract is hidden, and difficult to detect and define and, in this field of gas- troenterology, symptoms are often all, or nearly all, that WORKING PARTY REPORT Disorders of gastrointestinal motility:Towards a new classification 1 DAVID WINGATE,* MICHIO HONGO, † JOHN KELLOW, ‡ GREGER LINDBERG § AND ANDRÉ SMOUT ¶ *Barts & The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK, † Department of Comprehensive Medicine,Tohoku University, Sendai, Japan, ‡ Department of Gastroenterology, Royal North Shore Hospital, University of Sydney, Sydney, Australia, § Department of Medicine, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden and ¶ Department of Gastroenterology, Utrecht University Hospital, Utrecht, The Netherlands Correspondence: Professor David Wingate, The Wingate Institute, 26 Ashfield Street, London E1 2AD, UK. Email: d.l.wingate@mds.qmw.ac.uk 1 Working Team Report prepared for Organization mondiale de gastroenterologie (OMGE). © 2002 Blackwell Science Asia Pty Ltd