The complexities of pediatric motility disorders

Jan. 18, 2019

Pediatric gastrointestinal motility disorders are common and sometimes seen as benign. Yet often these disorders have complex causes, and patients can benefit from specialized pediatric gastrointestinal management.

"Even a disorder as common as constipation is not as straightforward as some people think. Different types need to be managed differently," says Mhd Louai Manini, M.D., a pediatric gastroenterologist at Mayo Clinic in Rochester, Minnesota. Children with constipation might have congenitally slow colons, anorectal malformations or pelvic floor problems.

Referral to a pediatric gastroenterologist may be beneficial for children with constipation and other motility problems, such as:

  • Dysphagia
  • Abdominal distension
  • Poor feeding tolerance
  • Chronic nausea and vomiting
  • Acid reflux

"Although constipation is the most common issue, we see kids whose motility problems are complicated by underlying conditions, such as spina bifida, spinal cord lesions, tumors or Hirschsprung's disease — a rare, congenital condition involving nerve cells in the colon that make it difficult to pass stool," Dr. Manini says.

The available testing includes:

  • Gastric small bowel and colonic transit studies
  • Anorectal manometry
  • Colonic manometry
  • Esophageal manometry
  • Gastroduodenal manometry

Esophageal manometry can detect rumination syndrome, in which people repeatedly and unintentionally regurgitate food, then rechew and swallow it. "Rumination is an underdiagnosed condition, because the tools to diagnose and manage it aren't common," Dr. Manini says. Children with rumination syndrome might be referred to a Children's Center behavioral psychologist, who can teach diaphragmatic breathing techniques that are effective for most people.

Gastroduodenal manometry is used to assess the strength of stomach contractions and their coordination with the small bowel. "This testing can be challenging to do in kids," Dr. Manini says. "But our team has expertise in caring for children and easing their concerns."

Once testing is completed, the treatment plan might involve medication, surgery or behavior therapy. Heller myotomy may be performed in children with achalasia. Children with Hirschsprung's disease generally require initial anorectal surgery and ongoing monitoring for future complications, such as strictures and incontinence.

For children with pelvic floor problems, physical therapists can provide pelvic floor therapy. Biofeedback might be used to teach children to relax and tighten pelvic floor muscles.

"Having these newer tools to evaluate children is a great benefit to guiding their management," Dr. Manini says. "Testing and treating children are often not as straightforward as managing care for adults. But we have the expertise and experience to offer complete management for pediatric patients."