Abdominal Pain-Related Functional Gastrointestinal Disorder and Disorders of Brain–Gut Interactions - 37

Chronic abdominal pain accounts for approximately 50% of referrals to pediatric gastroenterologists, with most children suffering from functional abdominal pain (FAP) disorders (FAPDs). FAPDs include functional dyspepsia, irritable bowel syndrome, abdominal migraine, and FAP–not otherwise specified. Etiologies include genetic predisposition and events that lead to disruption of the brain–gut–microbiota axis, such as environmental and psychosocial stressors, disruption of the gut microbiota, and early life events that lead to hyperalgesia, such as cow’s milk protein. FAPDs lead to impaired quality of life and increased health care costs. Unfortunately, treatment options are limited given most are studied in adults and not children, thus making FAPDs difficult to manage in pediatrics

189Pain disorders Introduction, assessment, and psychophysiology

This chapter aims to discuss types of pediatric gastrointestinal (GI) disorders that can lead to pain, as well as some of the therapeutic alternatives available to manage them

Gastric accommodation: Physiology, diagnostic modalities, clinical relevance, and therapies

Background Gastric accommodation is an essential gastric motor function which occurs following ingestion of a meal. Impaired gastric fundic accommodation (IFA) is associated with dyspeptic symptoms. Gastric accommodation is mediated by the vagal pathway with several important physiologic factors such as duodenal nutrient feedback playing a significant role. IFA has been described as a pathophysiologic factor in several gastrointestinal disorders including functional dyspepsia, diabetic gastropathy, post‐Nissen fundoplication, postsurgical gastrectomy, and rumination syndrome. Modalities for gastric accommodation assessment include gastric barostat, intragastric meal distribution via scintigraphy, drinking tests (eg, water load), SPECT, MRI, 2D and 3D ultrasound, and intragastric high‐resolution manometry. Several treatment options including sumatriptan, buspirone, tandospirone, ondansetron, and acotiamide may improve symptoms by increasing post‐meal gastric volume. Purpose Our aim is to provide an overview of the physiology, diagnostic modalities, and therapies for IFA. A literature search was conducted on PubMed, Google Scholar, and other sources to identify relevant studies available until December 2020. Gastric accommodation is an important gastric motor function which if impaired, is associated with several upper gastrointestinal disorders. There are an increasing number of gastric accommodation testing modalities; however, each has facets which warrant consideration. Evidence regarding potentially effective therapies for IFA is growing. After ingestion of a meal, the fundus of the stomach dilates in response to small increases in intragastric pressure to accommodate food, a reflex known as gastric accommodation. Disorders at the sensory level, vagal reflex pathway, intrinsic inhibitory innervation, gastric smooth muscle, or pathologic alteration of nutrient delivery rate to the duodenum adversely affect adaptive relaxation, leading to impaired fundic accommodation. Evidence regarding potentially effective therapies for impaired fundic accommodation is growing

Hematemesis in a Newborn: A Case Report

We present the case of a term-healthy neonate who developed hematemesis while being admitted at the newborn nursery. The infant was found to have gastric ulcers with duodenal eosinophils. The condition was conservatively managed and the symptoms, including ulcers, resolved with time; however, the etiology of the ulcers is still unknown

Childhood gastroparesis is a unique entity in need of further investigation

Background Despite increasing knowledge regarding gastroparesis (GP) in adults, little is known regarding the incidence, prevalence, and natural history of childhood GP. Exacerbating the knowledge gap in pediatric GP is both the lack of normative data for gastric emptying scintigraphy in children and lack of GP-specific pediatric reported outcome measures. Purpose The aim of this article was to review the available literature on pediatric GP and identify similarities and differences with studies in adults. We performed a comprehensive search in MEDLINE and Google Scholar from inception to April 2019 for articles published in English using the following combination of keywords: gastroparesis, pediatric gastroparesis, outcomes, metoclopramide, erythromycin, domperidone, cisapride, and gastric neurostimulator. The limited available pediatric data, often retrospective, suggest marked differences between adult and pediatric GP in several aspects including etiology, concomitant co-morbidities (eg, psychiatric disorders), clinical symptom presentation, diagnostic evaluation, response to therapies, and clinical outcome. Further research in pediatric GP is needed and holds the promise to further elucidate the mechanisms of this disorder in children and lead to pediatric-focused therapies