Advanced Training in GI Neuromuscular Disorders

This one-year program at Wake Forest School of Medicine offers advanced training in gastrointestinal (GI) neuromuscular disorders (NMDs) for GI fellowship graduates who wish to become experts in this gastroenterology subspecialty.

Our goal is for fellows to provide exceptional patient care and continue the educational and investigative work required to move this dynamic field forward.

Trainees will work under the guidance and supervision of three full-time faculty members who specialize in GI neuromuscular disorders:

  • Kenneth L. Koch, MD, Professor, Gastroenterology
  • Nyree Thorne, MD, Assistant Professor, Gastroenterology, and Director, GI Neuromuscular Disorders Center
  • Steven Clayton, MD, Assistant Professor, Gastroenterology

Why Advanced Training in NMDs?

Adequate training in all aspects of GI neuromuscular disorders is rarely achieved in most three-year GI fellowship programs. It requires an in-depth understanding of the pathophysiology, clinical presentation, diagnosis and therapy of these disorders.

Training in motility testing is challenging and requires intensive exposure to esophageal, gastric and colorectal testing using radiologic and manometric techniques. Our program gives fellows the hands-on experience necessary to become confident in this emerging subspecialty.

Clinical Training

The GI Neuromuscular Disorders Program at Wake Forest Baptist Medical Center is one of the busiest in the Southeast, accounting for more than 1,800 diagnostic procedures performed in the GI NMD procedures unit each year.

The trainee will spend at minimum four months dedicated to intensive clinical exposure in GI neuromuscular disorders, including:

  • Outpatient consultation clinics with GI NMD faculty focused on patients with a wide range of challenging GI neuromuscular disorders
  • Ongoing performance, review and interpretation of diagnostic studies, such as:
    • Esophageal manometry
    • Ambulatory pH/impedance monitoring
    • Anorectal manometry
    • Electrogastrography
    • Hydrogen breath testing
    • Antroduodenal and colonic manometry (primarily performed by our colleagues in pediatric gastroenterology)
    • SmartPill system

Trainees will spend two or three half-days per week in the outpatient consultative clinics of the faculty, which focus on patients referred with GI NMDs. Opportunities to participate in specialized therapies for GI NMDs, such as pneumatic dilation and Botox injection for achalasia and gastric electrical stimulation for gastroparesis, are also available.


The trainee will spend at least four months on dedicated research. During this time, clinical activities will be limited to include only outpatient clinic and rotation in the GI NMD procedures unit. The remaining four months will be dedicated to general GI service.

General GI service activities include:

  • Inpatient GI consult service (maximum four weeks)
  • Outpatient general endoscopy
  • Participating in the attending call rotation
  • Supervision of GI fellows in clinic, if needed

Advanced trainees are typically appointed to junior faculty positions at the instructor level.

Trainees will be expected to initiate at least one clinical research project during their year of training. As part of the GI NMD team, trainees will be expected to actively participate in ongoing prospective original and industry-sponsored clinical trials as well as complete at least one retrospective study.

Trainees will be supported to present their research at national meetings such as Digestive Disease Week of the American Gastroenterological Association, the American College of Gastroenterology, and the American Neurogastroenterology and Motility Society. In addition, trainees will be expected to write at least one book chapter, review article or case series.


Trainees will participate in clinical and research conferences held by the GI section every Tuesday and Thursday afternoon, including:

  • GI grand rounds
  • GI Journal Club
  • Interdisciplinary conferences with colleagues in radiology, pathology and surgery

Trainees will also participate in our GI NMD research meeting held every Tuesday and present one to two interesting or challenging cases at the GI NMD Clinical Conference held monthly.