Disorders involving the motility of the stomach and small intestine are significant medical problems. We have selected articles in four areas where exciting new advances have been made toward understanding these neuromuscular diseases. First, a recent paper has shown that in women gastrointestinal symptoms often wax and wane with the menstrual cycle, increasing at the midluteal phase, peaking at the onset of menstruation, and then rapidly decreasing until the next cycle. In our experience, this pattern has been strikingly apparent in these disorders. Second, we readdress the importance of the hypothalamus and its contribution to the overall expression of these neuromuscular disorders. Releasing factors that regulate pituitary function are emerging as important chemical modulators of systemic endocrine function in addition to their neuroendocrine effect on the gastrointestinal tract. Analogues of one of these releasing factors and an analogue of a neuropeptide are becoming priceless pharmacologic agents as well as important biologic probes for understanding pathophysiology. Third, the possible action of viruses as agents that cause these disorders, and the relationship of these disorders with chronic fatigue syndrome, are also discussed. Finally, we review an interesting paper regarding one of the mechanisms of diarrhea. These are exciting times in gastroenterology; we are at the frontiers of medical therapy and progress.
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