Pediatric Gastrointestinal Motility Research Articles

Nutritional Management of Pediatric Gastrointestinal Motility Disorders.

Normal and optimal functioning of the gastrointestinal tract is paramount to ensure optimal nutrition through digestion, absorption and motility function. Disruptions in these functions can lead to adverse physiological symptoms, reduced quality of life and increased nutritional risk. When disruption or dysfunction of neuromuscular function occurs, motility disorders can be classified depending on whether coordination or strength/velocity of peristalsis are predominantly impacted. However, due to their nonspecific presenting symptoms and overlap with sensory disruption, they are frequently misdiagnosed as disorders of the gut-brain interaction. Motility disorders are a prevalent issue in the pediatric population, with management varying from medical therapy to psychological therapy, dietary manipulation, surgical intervention or a multimodal approach. This narrative review aims to discuss the dietary management of common pediatric motility disorders including gastroesophageal reflux, esophageal atresia, achalasia, gastroparesis, constipation, and the less common but most severe motility disorder, pediatric intestinal pseudo-obstruction.

Training in pediatric neurogastroenterology and motility across Europe: a survey of the ESPGHAN National Societies Network 2016-2019.

BackgroundPediatric gastrointestinal motility disorders present significant challenges for diagnosis and management, emphasizing the need for appropriate training in Pediatric Neurogastroenterology and Motility (PNGM). The aim of this survey, part of a comprehensive survey on training in pediatric gastroenterology, hepatology and nutrition, was to evaluate training related to PNGM across European training centers.MethodStandardized questionnaires were collected from training centers through the National Societies Network of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), from June 2016 to December 2019.ResultsIn total, 100 training centers from 19 countries participated in the survey. Dedicated PNGM clinics were available in 22 centers; pH-monitoring in 60; pH/impedance in 66; standard manometry in 37; and high-resolution manometry in 33. If all motility studies were performed partially or fully by the trainees, the median (range) annual numbers/per trainee were as follows: pH-monitoring 30 (1-500); pH/impedance 17 (1-131); standard manometries 10 (1-150); and high-resolution manometries 8 (1-75). The motility assessment was performed by pediatric gastroenterologists (43 centers); adult gastroenterologists (10 centers); pediatric surgeons (5 centers); and both pediatric gastroenterologists and pediatric surgeons (9 centers). Annual numbers ≤10 for pH-monitoring, pH/impedance, standard manometries and high-resolution manometries were reported by 7 (12%), 15 (23%), 11 (30%) and 14 (42%) centers, respectively.ConclusionsSignificant differences exist in PNGM-related infrastructure, staff and procedural volumes at training centers across Europe. ESPGHAN and the National Societies should take initiatives to ensure the acquisition of competence in PNGM-related knowledge and skills, and develop strategies for assessment and accreditation.An infographic is available for this article at: http://www.annalsgastro.gr/files/journals/1/earlyview/2022/Infographic-AG6486.pdf

Understanding gastrointestinal motility studies in pediatrics

Motility of the gut is affected by the nervous system, the endocrine system, smooth muscle cells, interstitial cells of Cajal, secretory mucosal cells, the immune system, and gut flora. Abnormal gastrointestinal motility can generate nonspecific symptom complaints that are refractory to standard treatment approaches. It is important to exclude anatomical obstruction or other causes for patients' symptoms prior to proceeding with motility evaluation. Motility studies that help to evaluate children with suspected motility problems include combined multichannel intraluminal impedance (MII) and pH recording, esophageal manometry, gastric emptying scinitigraphy, antroduodenal manometry, colonic manometry, and anorectal manometry. Many pediatric gastrointestinal motility evaluations should be completed in a pediatric motility center where specialized training is completed by physicians in this field. Indications for pediatric gastrointestinal motility studies and how the procedures are performed are addressed in this paper.

Proceedings of the 2018 Advances In Motility and In NeuroGastroenterology: AIMING for the Future Single Topic Symposium.

Motility and functional disorders are common in children and often debilitating, yet these disorders remain challenging to treat effectively. At the 2018 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the Neurogastroenterology and Motility Committee held a full day symposium entitled, 2018 Advances In Motility and In NeuroGastroenterology - AIMING for the future. The symposium aimed to explore clinical paradigms in pediatric gastrointestinal motility disorders and provided a foundation for advancing new scientific and therapeutic research strategies. The symposium brought together leading experts throughout North America to review the state of the art in the diagnosis and management of motility and functional disorders in children. Presentations were divided into esophageal, antral duodenal, and colorectal modules. Each module included oral presentations by experts in the respective fields, leading to thought-provoking discussions. There were 2 breakout sessions with small group discussions on select topics, focusing on defining scientific insights into the diagnosis and management of pediatric functional gastrointestinal and motility disorders in a systematic, segment-based approach. The field of neurogastroenterology has made remarkable progress in the last decade. The current report summarizes the major learning points from the symposium highlighting the diagnosis and promising therapies on the horizon for pediatric neurogastrointestinal and motility disorders.

Nutrition Management in Pediatric Gastrointestinal Motility Disorders.

Gastrointestinal (GI) motility disorders are associated with suboptimal nutrition in children, mainly because of malabsorption and symptoms limiting dietary intake. Apart from medical therapy, nutrition support has a crucial role in maintaining growth and improving clinical outcomes in children. Based on recent data and guidelines, this review provides an overview of nutrition assessment and specific interventions for common pediatric GI disorders including gastroesophageal reflux disease, esophageal motility disorders, gastroparesis, chronic intestinal pseudo-obstruction, and constipation. Several approaches including diet modification, enteral nutrition (gastric vs post-pyloric, temporary vs permanent access, bolus vs continuous), and parenteral nutrition need to be tailored based on patient's nutrition and clinical assessment.

Pediatric Motility Disorders

Pediatric gastrointestinal motility disorders are a heterogeneous group of enteric nervous system disorders that continue to cause difficulties in children. The pathophysiology, diagnosis, and treatments of the most common disorders of the esophagus, stomach, small intestine, and colon will be discussed to understand the interplay between motility and sensory functions and the effect on gastrointestinal motility. Much remains unanswered in the pathogenesis of the majority intestinal motility disorders. Research has started to explore targeted gene mutations as potential causes of congenital motility disorders, which may be able to help better predict outcomes. An understanding of the relationship between the enteric nervous system the gastrointestinal tract, in combination with advancements in motility studies, technology, and gene therapies, will help point towards potential for novel therapies.

Parent Perceptions of the Psychological Functioning of Their Children Diagnosed With Pediatric Motility Disorders and That of Family Members

The aim of our study was to characterize the parental perceptions of the behavioral and emotional functioning of their children and families coping with gastrointestinal motility disorders. The American Pseudo-obstruction and Hirschsprung's disease Society sponsored an educational meeting for parents of children afflicted with a variety of pediatric gastrointestinal motility disorders. During the conference, parents completed a questionnaire pertaining to the behavioral and emotional functioning of the afflicted child and other family members. Parents perceived that the child's illness was more difficult on the parents than on the affected child or their siblings. Also, parents perceived support from professionals, family, and friends increased after the children were diagnosed with pediatric gastrointestinal motility disorders. Parents worried most about the health and medical management of their afflicted child. The most common behavioral problem of the afflicted children was fear of separation, whereas the most common behavioral problem of their siblings was jealousy. The majority of referrals to mental health professionals resulted from parental emotional problems or marital discord.

125 QUALITATIVE ANALYSIS OF FASTING ANTRODUODENAL MANOMETRY.

Antroduodenal manometry has been used to determine the pathophysiology associated with signs and symptoms of motility disorders. The value of antroduodenal manometry has been limited by a paucity of data from normal children. In this study, we compared antroduodenal manometry from 95 children (mean age 4.6 y, range 2 mo-20 y, 52 male) with symptoms suggesting a motility disorder to 20 control children without upper gastrointestinal tract symptoms(mean age 7.5 y, range 2 mo-18 y, 10 male). A single investigator unaware of the patient histories visually analyzed the qualitative features of the record for the first 4 h following a 12 h preparatory fast. Phase 3 of the migrating motor complex was less frequent in patients (P < 0.05), especially in those who required total parenteral nutrition (P < 0.001), than in controls. Stationary or retrograde phase 3 migration and intervals <30 min between phase 3s were more frequent in patients than in controls (P < 0.01 and P < 0.05, respectively). Short (<3 min) or prolonged (>10 min) phase 3 duration, absence of phase 1 following phase 3, tonic pressure increases >10 mmHg for longer than 1 min during phase 3, low amplitude of phase 3 contractions in a single recording site, clustered contractions (12/min contractions for more than 30 s), and prolonged propagating contractions (propagating over 6 cm or more within 6 s, with amplitude >30 mmHg, and duration >6 s at more than 1 recording site) were not more frequent in patients than in controls. During phase 2, persistent low amplitude contractions in all recording sites and sustained tonic pressure increases (>10 min in one recording site) were found only in parenteral nutrition-dependent children. We conclude that there are five features having a clear association with pediatric gastrointestinal motility disorders: 1) absent phase 3, 2) abnormal phase 3 migration, 3) short intervals between phase 3s, 4) persistent low amplitude contractions, 5) sustained tonic contractions. These results suggest that several qualitative features of antroduodenal manometry considered abnormal in adults may be within the spectrum of normal variation in children.