Advances in Motility & in Neurogastroenterology: AIMING for the Future - Single Topic Symposium

Chair: Anil Darbari MD, MBA 

Associate Professor of Pediatrics
George Washington University School of Medical Health Sciences
Director, Comprehensive GI Motility Center
Children's National Medical Center

WEDNESDAY, OCTOBER 24

Objectives:
This single topic symposium aims to bring together world’s leading clinicians and scientists in a didactic exchange on the state of the art in pathophysiology, diagnosis and management of pediatric gastrointestinal motility related sensory conditions, and to build a foundation for advancing new scientific and therapeutic strategies. The symposium will emphasize and promote the participation of young investigators, including trainees and junior faculty.
We aim to provide a foundation for future research and to inspire young investigators to study and practice pediatric neurogastroenterology and gastrointestinal motility.

The symposium will provide cutting edge presentations from adult and pediatric practitioners and is organized into modules that define the state of the art in the diagnosis and management of functional disorders of the gastrointestinal tract, frame key questions, define the underlying pathophysiology, and highlight novel therapies on the horizon.

Participants will also have hands-on demonstrations of the most up-to-date equipment and can contribute to discussions about neuromodulatory therapies in smaller groups. This symposium will provide the participants with an in-depth understanding of the current field of pediatric neurogastroenterology and motility, highlighting how the field is advancing, AIMING for the future.

 

8:00am – 8:10am - Introduction to the course 
Jaime Belkind-Gerson MD, MSc, Chair, Neurogastroenterology and Motility Committee

Module 1 – The pediatric esophagus: The diagnosis and management of dysphagia, pain, cough and beyond

Moderators: John Rosen MD, Robert O. Heuckeroth, MD PhD

8:10am – 8:30am  Insights into esophageal physiology and function: Using novel technologies to understand health and disease
Samuel Nurko MD, MPH, Boston Children’s Hospital
  Objectives:
  • Discuss the normal function of the UES, esophageal body and LES
  • Discuss the primary mechanisms behind GERD, LES and UES achalasia
  • Review the common HRM findings of primary and secondary motility disorders
  • Discuss the indications for esophageal function testing
  • Discuss the indications for reflux testing
  • Discuss the novel tests for assessing esophageal function (esophageal topography, cough catheters, HRM with impedance)

8:30am – 8: 40am  Junior Investigator Presentation

8:40am – 9:00am  Motility meets aerodigestive: The interaction between upper tract dysmotility and the airway
Rachel Rosen MD, MPH, Boston Children’s Hospital
  Objectives:
  • Discuss the role of motility testing in the evaluation of respiratory symptoms
  • Discuss the data showing the interaction between dysmotility, reflux and respiratory disease
  • Discuss the data on therapies for motility and GER and the airway

9:00am – 9:20am  Management of esophageal motility disorders: Achalasia, esophageal atresia, and the post-fundoplication esophagus
Ajay Kaul MD, Cincinnati Children’s Hospital Medical Center
  Objectives:
  • Discuss how the diagnostic testing shapes the decision to intervene in the obstructed esophagus
  • Discuss the endoscopic and surgical interventions for the management of the obstructed esophagus
  • Discuss differential diagnosis and the role for additional testing in the persistently symptomatic, post-dilation/post myotomy patient

9:20am – 9:40am  Keynote Lecture:Novel therapies for functional esophageal disorders
John E Pandolfino MD, MSCI, Northwestern University
  Objectives:
  • Discuss the differential diagnosis for functional esophageal disorders
  • Discuss how diagnostic testing may shape your choice of therapies
  • Discuss the therapeutic outcomes for medical therapies for functional esophageal disorders
  • Discuss the therapeutic outcomes for behavioral therapies for functional esophageal disorders

9:40am – 9:55am    QUESTION AND ANSWER SESSION

Module 2 – Gastric and small intestinal sensory and motor dysfunction

Moderators: Jose Cocjin MD, Alex Flores MD

10:00am – 10:20am Gastric motility: How it works, how we feel it and how to test it
Elyanne Ratcliffe MD, McMaster Children’s Hospital
  Objectives:
  • Identify the main neuronal pathways involved in the regulation of gastric motility and sensation
  • Translate how the basic physiology of gastric motility and sensory processing is relevant to patient care
  • Assess appropriate indications for the use of diagnostic tests in the evaluation of gastric motility

10:20am – 10:30am  Junior Investigator Presentation

10:30am – 10:50am  Pseudoobstruction: Clinical presentation, etiology, diagnostic measures & therapeutic intervention
Desalegn Yacob MD, Nationwide Children’s Hospital
  Objectives:
  • Review the clinical presentation and etiology of intestinal pseudoobstruction
  • Explore and discuss the available diagnostic measures
  • Discuss the therapeutic interventions and their effectiveness

10:50am – 11:10am  Abdominal Migraine, Functional Dyspepsia, Cyclic Vomiting and All that comes with it
B U K Li MD, Medical College of Wisconsin
  Objectives:
  • Review the role of sensory modulation in functional conditions of stomach and small intestine
  • Discuss clinical features, diagnostic criteria and management options of cyclic vomiting
  • Learn about the pharmacologic and non-pharmacologic management of refractory vomiting, with special emphasis on functional GI disorders of stomach and small intestine

11:10am – 11:30am   Non-pharmacologic management of nausea and vomiting
Anil Darbari MD, MBA, Children’s National Health System
  Objectives:
  • Discuss the role of antroduodenal manometry in evaluation of nausea and vomiting
  • Review options for management of refractory nausea and vomiting
  • Learn about the advantages and disadvantages of gastric pacemakers

11:30am – 11:45am   QUESTION AND ANSWER SESSION

11:45am – 12:15pm   LUNCH BREAK 

Breakout  Sessions 1 

Breakout  Sessions 1   - 12:15pm – 1:00pm
(Select one to attend)

Session 1A: Hands-On Demonstrations
Hands-on Esophageal Manometry
John Rosen MD/ Ajay Kaul MD
  Objectives:
  • Review indications for pediatric esophageal manometry
  • Demonstrate esophageal manometry best-practice techniques and troubleshooting strategies
  • Understand esophageal manometry data interpretation and patient application

Hands-on pH Impedance
Jose Cocjin MD/ Rachel Rosen MD, MPH
  Objectives:
  • Determine when pH/MII and wireless pH testing are needed in children
  • List potential utility and limitations of pH/MII and wireless pH monitoring
  • Identify key concepts in pH/MII and pH testing reports, including the clinical application of this data

Session 1B: Next steps in the pediatric esophagus- POEM, esophageal topography, and more
John Pandolfino MD/ John Fortunato, MD
  Objectives:
  • Review state of the art devices related to esophageal motility evaluation and treatment
  • Understand differences in the use of POEM, esophageal topography and other devices in children compared to adults
  • Discuss future directions/needs in esophageal device development


Session 1C: Psychological treatment options in functional GI disorders  
Laurie Keefer PhD/ Rose Schroedl MD

  Objectives:
  • Discuss available psychological treatment options for patients with functional GI disorders (FGIDs)
  • Discuss rationale for using behavioral interventions and summarize evidence of effectiveness in FGIDs with focus on hypnotherapy
  • Summarize evidence of effectiveness of hypnotherapy in FGIDs
  • Characterize which FGID patients should be considered for referral

Session 1D: Multidisciplinary team building
Samuel Nurko MD/ Joel Friedlander MD

  Objectives:
  • Review models of multidisciplinary pediatric pain and aerodigestive programs and their effectiveness
  • Describe the process of building a multidisciplinary team
  • Review steps towards implementing current care standards for children with complex aerodigestive diseases and pain disorders

Session 1E: From bench to bedside: Navigating an academic career in pediatric gastroenterology and motility
Robert O. Heuckeroth MD, PhD/ Meenakshi Rao MD, PhD

  Objectives:
  • To define key questions in bowel motility disorders that need to be addressed by translational research strategies.
  • To delineate new therapeutic and diagnostic strategies for treating and preventing bowel motility disorders based on the newest science.
  • To discuss opportunities and challenges of academic career trajectories that combine basic science and clinical care.
  • To facilitate career development for physicians and scientists interested in bowel motility disorders.

Session 1F: Special session: Manometry tracings, difficult cases in GI motility (In Spanish)
Leonel Rodriguez MD, Alex Flores, MD

  Objectives:
  • To review difficult cases presenting with GI symptoms at a GI Motility Center
  • Discuss how esophageal manometry, pH impedance studies and antroduodenal manometry studies help in the diagnosis of these conditions
  • Review sample tracings from these procedures

Module 3 – Advances in evaluation and management of anorectal and colonic dysfunction

Moderators: Meenakshi Rao MD Ph D, Jaime Belkind-Gerson MD, MSc

1:30pm – 1:50pm - Basic pathophysiology of colonic and anorectal function: transit studies, nuclear medicine and wireless motility capsule
Lusine Ambartsumyan MD, Seattle Children’s Hospital
  Objectives:
  • Embryology and development that underlie colon and anorectal function
  • Colonic anatomy, innervation, motor and sensory function
  • Pelvic floor anatomy, innervation, motor and sensory function and defecation physiology
  • Anorectal malformations and associated functional and sensory deficits
  • Post-natal development of anorectal function and physiology

1:50pm – 2:10pm  Evaluation of anorectal function  
Jaya Punati MD, Children’s Hospital Los Angeles
  Objectives:
  • Fluoroscopic defecography studies
    - Magnetic Resonance (MR) defecography 
   - Endoscopic ultrasound of anal sphincter
   - Anorectal Manometry (ARM) (How the study is done, types of equipment, information obtainable, age related differences and utility in management- TO BE DISCUSSED IN HANDS ON)
  • Utility of ARM in pelvic floor dysfunction
  • ARM findings in spinal malformations
  • Unusual manometry findings (hypertonic sphincter, exaggerated slow waves etc., unusual Recto Anal Inhibitory Reflex (RAIR) morphology, advantage of 3D-ARM

2:10pm – 2:30pm  Evaluation of colonic function
Manu Sood MD, Medical College of Wisconsin
  Objectives:
  • TRANSIT STUDIES 
    - Radiopaque Markers                                                                           
    - Scintigraphy, wireless motility capsule
  • Colonic Manometry: (How the study is done, types of equipment, what information is obtainable, age related differences and utility in management- TO BE DISCUSSED IN HANDS ON)
  • Discuss disease states of partial or total colonic inertia, Hirschsprung's disease
  • Myopathic patterns of dysfunction
  • Neuropathic patterns of dysfunction

2:30pm – 2:40pm  Junior Investigator Presentation

2:40pm – 3:00pm  KEYNOTE LECTURE:New insights in management of intractable constipation
Satish S C Rao MD PhD FRCP, Augusta University
  Objectives:
  • Medications new/off label/ in the horizon (R&D)
   • Behavioral modification (bio-feedback/ physical therapy, pelvic floor therapies)
  • Surgical approaches/ Advancements                           
  • Rectal Therapies (retrograde enemas, anal irrigation systems)

3:00pm – 3:20pm  Surgical options in management of functional constipation: When medical management fails
Marc A Levitt MD, Nationwide Children’s Hospital
  Objectives:
  • Surgical options for functional constipation and failed medical management
  • To be covered in concurrent sessions:
    - Advances in surgical approaches / implantable devices
    - Sacral nerve stimulator

3:20pm – 3:35pm   QUESTION AND ANSWER SESSION

Breakout Sessions 2

4:00pm – 4:45pm (Select one to attend)

Session 2A: Hands-on Demonstrations
Hands-on Anorectal Manometry (ARM)
Satish Rao MD/ Jaya Punati MD
  Objectives:
  • Understand the utility of ARM in the evaluation of constipation and encopresis
  • Become familiar with the different testing components of ARM
  • Be able to analyze, interpret and apply the ARM findings

Hands-on Colonic Manometry (CM)
Manu Sood MD/ Khalil El-Chammas MD

  Objectives:
  • Understand the utility of CM in the evaluation of constipation and encopresis
  • Be able to analyze, interpret and apply the CM findings

Session 2B: Cecostomy, Ileostomy, Colostomy
Marc Levitt, MD/ Karla Vaz, MD

  Objectives:
  • Understand the indications and selection criteria for the ostomy procedure
  • Become familiar with the management of regimen to maintain ostomy flushes
  • Understand the issues of after-care from medical and surgical point of view
  • Learn how to decide on reversal or take-down

                                                           
Session 2C: Dietary and Non-pharmacologic management options for pain/IBS
Bruno Chumpitazi MD/ Julie Khlevner MD/ Rina Sanghavi MD

  Objectives:
  • Review the current understanding of the brain-gut microbiome axis
  • Review dietary approaches in FGID treatment and evaluate the current evidence to support their efficacy

Session 2D: Transit studies: Methods and interpretation (Radio opaque markers, Scintigraphy, Wireless Motility Capsule)
Leonel Rodriguez MD/ Jaime Belkind-Gerson MD/ Sravan Reddy Matta MD

  Objectives:
  • Become familiar with the different tests available to study gastrointestinal transit
  • Be able to interpret these tests and apply them to clinical practice

Session 2E: Anorectal and colonic manometry: Difficult cases (In Spanish)
Miguel Saps, MD/ Jose Garza, MD

  Objectives:
  • To review difficult cases presenting at a GI Motility Center
  • To review which procedures are best recommended
  • To learn about information gathered from sample tracings
  • To discuss how these procedures are helpful in management decisions

State of the Art Pediatric Neurogastroenterology Lecture

5:15pm – 5:45pm  Pediatric Neurogastroenterology: Where it started and where it is headed
Carlo Di Lorenzo MD, Nationwide Children’s Hospital
  Objectives:
  • To review history of pediatric neurogastroenterology
  • Discuss the current diagnostic and therapeutic approaches to children with these conditions
  • Learn about the developments in the field of pediatric neurogastroenterology

5:45pm – 5:50pm  Concluding Remarks
Anil Darbari MD, MBA, Children’s National Health System

CME Information

Acknowledgement of Commercial Support 


ACCREDITATION STATEMENT

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGAN) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physician
The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. NASPGHAN designates this live activity for a maximum of 7.75 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflict of Interest
The following table of disclosure information is provided to learners and contains the relevant financial relationships that each individual in a position to control the content disclosed to NASPGHAN.  All of these relationships were treated as a conflict of interest, and have been resolved.  (C7 SCS 6.1-­‐6.2, 6.5)
All individuals in a position to control the content of CE are listed in the program book. If their name is not listed below, they disclosed that they had no relevant financial relationships.