Publication Highlights Advances in Motility and Neurogastroenterology

The State of Pediatric Neurogastroenterology

The relationship between the brain and the gut has been long recognized, but the subspecialty of neurogastroenterology is a relatively new one, especially in the world of pediatrics.

While serving as Chair of Neurogastroenterology and Motility for the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, or NASPGHAN, Jose Cocjin, MD, Chief, Section of Neurogastroenterology and Motility, Children’s Mercy Kansas City, proposed a symposium focused on this emerging topic.

The result was a full-day symposium presented at the 2018 NASPGHAN meeting entitled Advances in Motility and Neurogastroenterology — AIMING (Advances in Motility & in Neurogastroenterology) for the Future.

Exploring Pediatric Neurogastroenterology

This symposium brought together more than 35 leading experts from throughout North America to review the state-of-the-art advances in the diagnosis and management of motility and functional disorders in children. More than 350 attended the event. Representing Children’s Mercy were Dr. Cocjin and his colleague, John Rosen, MD, pediatric gastroenterologist. The NASPGHAN symposium explored clinical paradigms in pediatric gastrointestinal motility disorders and provided a foundation for advancing new scientific and therapeutic research strategies. Presentations were divided into esophageal, antral duodenal and colorectal modules. Breakout sessions focused on scientific insights into the diagnosis and management of pediatric functional gastrointestinal and motility disorders in a systematic, segment-based approach.

Publishing Symposium Proceedings

The result of the 2018 symposium was the online publication of the proceedings in the Journal of Pediatric Gastroenterology and Nutrition in May 2020.¹

Topics addressed in the proceedings included:

• The Pediatric Esophagus: The Diagnosis and Management of Dysphagia, Pain, Cough and Beyond

• Gastric and Small Intestinal Sensory and Motor Dysfunction

• Advances in Evaluation and Management of Anorectal and Colonic Dysfunction

The proceedings included insights into sophisticated technology developed to measure the motor and sensory characteristics of the upper and lower GI tract, leading to improved understanding of the pathophysiology of most childhood neurogastroenterological disorders. The current trend in the field is to try to develop less invasive, but equally informative, diagnostic tests to possibly replace the more invasive traditional manometry in children.

More to Learn

There is still a great deal to learn about the genetics of bowel motility disorder, and about nongenetic factors that affect motility in children. Treatment options for children with neurogastroenterological disorders include medications that target the GI tract and others that are directed to the brain. 

Treatment should be tailored in the context of the biopsychosocial model. Techniques that in the future are likely to help children with the most severe forms of bowel motility disorders include neuromodulation and selective manipulation of gut microbiota. Regenerative medicine, optogenetics, and the development of more gut-selective medications represent other promising treatments.

The authors concluded that pediatric neurogastroenterology has made remarkable progress in the last decade. The tremendous interest and participation in this symposium provided further evidence for continuing interest in the field, indicating that the future is bright for children with motility and functional bowel disorders.

Building a Model Pediatric Motility Program

Dr. Cocjin and his colleagues at Children’s Mercy are among the leaders in this subspecialty, building one of a handful of programs in the nation utilizing a multidisciplinary approach to care. In fact, two new faculty trained and experienced in neurogastroenterology and motility were recently recruited to join the team, making it one of the largest and most comprehensive in the country focused on diagnosing and treating complex neurogastroenterology issues.

In addition to neurogastroenterology, other disciplines involved in the Children’s Mercy program include otolaryngology, urology, pediatric surgery, physical therapy, psychology, nursing and nutrition. The program provides consultation and follow-up for nearly 1,500 patients, and offers testing services to almost 300 patients annually. 

The Pediatric Motility program also offers access to a comprehensive suite of diagnostic modalities, including detailed pH/impedance studies and a wireless motility capsule that tracks gastrointestinal transit by measuring temperature and pH levels of the gastrointestinal system.

The Biopsychosocial Approach

At Children’s Mercy, traditional medical treatment is combined with a biopsychosocial approach to care, consistent with the recently published proceedings. In fact, a clinical psychologist works closely with the treatment team, ensuring that patients and families have the opportunity to explore the various factors that interact with and contribute to their diagnosis. This helps the team create a comprehensive treatment plan to address each child’s individual needs.

Additional leading-edge therapies being integrated into the Children’s Mercy Pediatric Motility program are biofeedback, hypnosis, acupuncture and alternative and complementary treatment methods.

Sources

1. Proceedings of the 2018 Advances in Motility and in Neurogastroenterology: AIMING for the Future Single Topic Symposium. Ambartsumyan L, Khlevner J, Nurko S, Rosen R, Kaul A, Pandolfino JE, Ratcliffe E, Yacob D, Li BUK, Punati J, Sood M, Rao SSC, Levitt MA, Cocjin JT, Rodriguez L, Flores A, Rosen JM, BelkindGerson J, Saps M, Garza JM, Fortunato J, Schroedl RL, Keefer LA, Friedlander J, Heuckeroth RO, Rao M, El-Chammas K, Vaz K, Chumpitazi BP, Sanghavi R, Matta SKR, Danialifar T, Di Lorenzo C, Darbari A. Journal of Pediatric Gastroenterology and Nutrition: April 13, 2020 - Volume Published Ahead of Print - Issue - doi: 10.1097/ MPG.0000000000002720.

Learn More About Pediatric Neurogastroenterology and Motility at Children's Mercy
 

Jose Cocjin, MD
Chief, Section of Neurogastroenterology and Motility
jtcocjin@cmh.edu
(816) 234-3066
transformpeds.childrensmercy.org

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