The Functional GI and Motility Disorders Clinic at UNC Hospitals is the premier site, both nationally and internationally, for referral of patients with functional GI and motility disorders (FGID). The clinic’s unique multi-disciplinary, patient-centered approach integrates medical, physiological and psychological factors in the evaluation, understanding and treatment of patients with these disorders. The clinic also serves as a leading tertiary referral site for patients who have difficult-to-diagnose illnesses or challenging disease/disorder management issues. The clinic’s services and educational activities have expanded over the last few years. Clinical providers include Yehuda Ringel, MD, Yolanda Scarlett, MD, Spencer Dorn, MD, MPH, Danielle Maier MPAS PA-C, and Robin Dever, RN.
On some afternoons, the clinic is also staffed with a Fellow (gastroenterologist in training), who is supervised by an attending physician. The Center’s clinical personnel are also routinely involved with consulting on patients at UNC Hospitals with severe functional GI or motility disorders and with physicians who call for advice regarding their patients. The clinic often has visiting gastroenterologists and trainees from other states and countries who are interested in learning more about the clinical approach, diagnosis and treatment of FGID patients. They also learn how to improve their interviewing and patient skills (see Visiting Scholars).
Associate Director, Center for Functional GI and Motility Disorders
Dr. Ringel is an Associate Professor of Medicine and the Associate Director of the UNC Center for FGIMD. Dr. Ringel has been involved with clinical and research of FGIMD more than 15 years. Dr. Ringel is committed to clinical work as a gastroenterologist specializing in FGIMD and research aiming to increase the understanding of these disorders and development of new treatments for patients with these disorders.
Dr. Ringel's clinic is a tertiary referral site for patients with complicated and difficult to treat upper GI disorders (e.g., nausea, vomiting, gastroparesis, and functional dyspepsia), lower GI disorders (chronic constipation, diarrhea and IBS) and generalized motility disorders (e.g., functional abdominal pain, abdominal bloating and chronic intestinal pseudo-obstruction). Dr. Ringel has been the principal investigator on numerous clinical trials investigating the etiologies, pathophysiological mechanisms, psychosocial aspects, and treatments of these disorders. Dr. Ringel’s clinical and research work have been recognized nationally and internationally and he is frequently invited to share his experience at leading universities, academic hospitals, and professional and scientific meetings.
Director, GI Motility Lab
Dr. Scarlett is the medical director for the motility laboratory. Her main clinical interests are anorectal disorders, constipation, fecal incontinence, general endoscopy and nonsurgical treatment of hemorrhoids and anal fissures. Dr. Scarlett received her medical degree from the University of North Carolina at Chapel Hill and completed her internal medicine residency and gastroenterology fellowship at UNC.
Director, GI Medicine Clinic
Dr. Dorn is a gastroenterologist who focuses on functional GI and motility disorders. Through his four-year fellowship at UNC he completed advanced training in functional gastroenterology (under Dr. Drossman). Additionally, through an American Neurogastroenterology and Motility Society fellowship he completed advanced training in gastrointestinal motility. Dr. Dorn is also Director of the GI Clinic at UNC Hospital.
Dr. Dorn received his undergraduate degree, with highest distinction, from the University of Michigan; his medical degree, summa cum laude, from SUNY at Brooklyn College of Medicine; and a Masters in Public Health from the University of North Carolina at Chapel Hill. Dr. Dorn completed his internal medicine training at Brigham and Women's Hospital, where he was a clinical fellow at Harvard Medical School. He subsequently trained at UNC as a Post-Doctoral Research Fellow in Digestive Diseases Epidemiology and later as a clinical fellow in Gastroenterology and Hepatology. Upon completion of his training Dr. Dorn joined the UNC faculty as an Assistant Professor of Medicine. His clinical and research interests are in health services (including care delivery, outcomes, and policy) for digestive diseases, particularly functional GI disorders.
Administrative and Clinical Aspects of GI Motility Services
Danielle Maier is a Physician Assistant that has worked in Functional bowel and motililty at UNC for 9 years. Ms. Maier is seeing patients with Dr. Yehuda Ringel, supervising physician, and Dr. Yolanda Scarlett at the UNC FGIMD Clinic two half clinic days a week. She also has her own clinic two half days a week, seeing both new patients and returns. Her patient population includes those with motility disorders, constipation, nausea and vomiting, gastroparesis, SIBO, pelvic floor dyssynergia, etc. She read and interprets anorectal manometries and hydrogen breath tests (lactose intolerance, small bowel bacterial overgrowth, and Helicobacter pylori breath tests) for UNC Hospitals. She has also been involved in clinical research with Dr. Ringel for 9 years.
Robin Dever is a registered nurse and works with Drs. Ringel, Dorn, Scarlett, and Danielle Maier, MPAS, PA-C in clinic and helps to triage patient questions, scheduling for diagnostic tests, and other important aspects to help the clinic run smoothly and efficiently.
Administrative Assistant for Clinical Services
Mrs. Layton is an administrative assistant for clinical services. She facilitates the referral and scheduling process as well as providing support and information to patients seeking treatment.
The GI motility Laboratory
The GI Motility Program at UNC Hospitals was established by Dr. William Whitehead. The clinical motility program including the GI Motility laboratory and the Pelvic Floor Biofeedback Retraining services are directed by Dr. Yolanda Scarlett.
The GI Motility Laboratory provides comprehensive diagnostic evaluation and advice on management of patients with a variety of GI motility disorders. The following services are provided by the GI Motility Laboratory:
- Diagnostic anorectal motility tests for fecal incontinence, constipation or rectal pain
- Ambulatory pH and impedance testing
- Esophageal motility testing
- Hydrogen breath tests for small bowel bacterial overgrowth and carbohydrate malabsorption
- Breath tests for h. pylori infection
- Motility wireless capsule (SmartPill) testing of gastric, small bowel, colonic and whole gut transit
- Biofeedback treatment for fecal incontinence, constipation, or rectal pain
Patients with GI motility disorders are seen initially in the Functional GI and Motility Disorders Clinic, the UNC Esophageal Clinic or they may be referred directly to the GI Motility Service by referring physicians for diagnostic motility testing and advice on further management. Diagnostic motility tests may be scheduled directly by outside physicians, but a medical consultation from one of the clinicians affiliated with the GI Motility Service is recommended.
Pelvic Floor Biofeedback Retraining
The UNC GI Motility program provides a unique dedicated clinical service of pelvic floor biofeedback retraining treatment for patients with fecal incontinence, constipation due to pelvic floor dyssynergia, and chronic rectal pain. The service is provided by a full-time biofeedback therapist. Biofeedback retraining treatment may be scheduled through consultation with one of the clinicians of the UNC Functional GI and Motility Disorders Clinic.
Mary Scholz, PhD, RN
Ms. Scholz is the full time biofeedback provider and RN in the Motility department of UNC. She came to UNC from Seattle, Washington, in September of 2009. Prior to working at UNC, she was the Director and owner of Mind Body Health PLL C, which provided biofeedback, counseling and hypnosis training to client with chronic pain, headache, and stress related disorders management. Mary holds an undergraduate degree in Nursing, a master’s degree in Behavioral Medicine and a PhD in Psychophysiology. She has taught courses on psychophysiology, pain, headache and stress related disorders in undergraduate and graduate courses. For several years she wrote a column for RN Magazine called Pain Clinic. She is on the Board of Directors for the Behavioral Research and Training Foundation, which offer courses on biofeedback and psychophysiology.
Sheila Crawford, RN
Lead Nurse in Motility Clinic
Ms. Crawford is the head nurse for the GI Motiltiy Lab.
As part of our unique multi-disciplinary, patient-centered clinical approach our clinical program also provides integrated Psychological Services. When the medical evaluation of a patient visiting the Functional GI and Motility Disorders Clinic suggests that psychological evaluation, advice and/or intervention may be beneficial for an individual patient, a psychological consultation is offered and may be brought into the patient’s care.
The psychological services are provided by Dr. Cara O'Connell-Edwards - a licensed clinical psychologist. Dr. O'Connell-Edwards specializes in the treatment of patients with chronic gastrointestinal illnesses and provide the following psychological techniques or therapies in collaboration with the patient’s other healthcare providers:
- Stress Management: Stress management therapy seeks to help a person understand the role of stress in his/her life and how it relates to the person’s FGID symptoms. It also seeks to provide the patient with a variety of ways for dealing with stressful events in ways that minimize their impact on the person’s FGID symptoms and quality of life.
- Cognitive Behavioral Therapy (CBT): CBT focuses on the interrelationship between a patient’s thoughts (cognitions), actions (behaviors) and feelings (affect), and the role they play in their FGID symptoms. A common example is to beat the “vicious cycle” that occurs when chronic severe symptoms lead to psychological distress which, in turn, worsens the symptoms. By understanding and focusing on the psychological components of the “brain-gut axis”, changes can be made in how a patient thinks, acts and feels about his/her GI difficulties, and thereby help reduce the frequency and intensity of FGID symptoms.
- Relaxation Therapy: Relaxation therapies to reduce a person’s current state of physical and psychological activation include progressive muscle relaxation (PMR), autogenic training, breath regulation, and meditation. With these techniques, a person can learn how to “turn down the volume” on their GI symptoms by becoming more calm and relaxed about them.
Assistant Clinical Professor
Dr. Cara O’Connell-Edwards is an Assistant Clinical Professor in Division of Gastroenterology and Hepatology. Dr. O’Connell-Edwards works in conjunction with Drs. Ringel, Dorn, Scarlett, and Danielle Maier, MPAS, PC-C, to aid in the continued care of patients with functional GI disorders. She completed her Postdoctoral Fellowship at Duke University Medical Center in the Department of Psychiatry and Behavioral Sciences and received her PhD and Master’s degrees in Clinical Psychology at West Virginia University. She also completed her Medical Psychology Pre-doctoral Internship at Duke University Medical Center’s Department of Psychiatry and Behavioral Sciences, Division of Medical Psychology.
She has expertise in both cognitive and dialectical behavior therapy, as well as guided imagery and hypnosis. Dr. O’Connell-Edwards is interested in the application of these modalities to coping with chronic pain, medical illness, anxiety disorders, and depression. Dr. O’Connell-Edwards also has a background in rehabilitation psychology, and consultation-liaison services for medically ill populations.