Research Agenda for Pediatric Gastroenterology, Hepatology and Nutrition: Motility Disorders and Functional Gastrointestinal Disorders: Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the Children's Digestive Health and Nutrition Foundation

Motility disorders and functional gastrointestinal (GI) disorders are interrelated. The first category refers to disordered esophageal, gastric, intestinal and colonic motility and encompasses achalasia, gastroparesis, Hirschsprung’s disease and chronic idiopathic intestinal pseudo-obstruction (CIIP). The second category encompasses disordered swallowing, vomiting, diarrhea, defecation and functional abdominal pain syndromes such as functional dyspepsia and irritable bowel syndrome (IBS). Both motility disorders and functional GI disturbances are exciting and fertile areas of current research. New Rome diagnostic criteria for pediatric functional GI disorders were published in 1999 and require validation and correlation with pathophysiologic findings. There has been an explosion of relevant basic science investigations in enteric neurobiology, genetics, brain-gut mapping and receptor physiology. Clinical research infrastructure. Progress in our understanding of pathophysiology and in the development of effective therapies will be facilitated by establishment of a clinical research infrastructure to support collaborative interdisciplinary research endeavors. In particular, such an infrastructure can provide long-term support for urgently needed prospective multicenter trials that can serve as the evidence base for development of diagnostic and therapeutic algorithms. In addition, consensus conferences are recommended to establish a) standardized diagnostic criteria for symptom-based diagnoses, b) subgrouping/stratification schemes, as well as c) clinical and pathophysiologic testing protocols for both motility disorders and functional disorders. Efforts in some of these areas have begun with the aid of the American Motility Society, Cyclic Vomiting Syndrome Association, National Institutes of Health (NIH), and the Rome Committee for functional GI disorders. Diagnostic tests and techniques used to evaluate motility disorders and functional GI disorders would be more widely accepted if technical protocols and methods of interpretation were validated and standardized. Such techniques include electrogastrography (EGG) for gastric dysrhythmias, impedance measurement in gastroesophageal reflux (GER), the barostat for visceral hyperalgesia and antroduodenal and colonic manometry for motility disorders. Fellowship and post-fellowship training. To develop a cadre of future clinical and basic science researchers, opportunities must be created for young pediatric gastroenterology investigators for training and mentoring in motility, functional GI and laboratory research. Fellowship and post-fellowship training with senior investigators is recommended in the areas of GI motility, sensory evaluation, functional neuroimaging and functional GI disorders. Centers of excellence. There is a need to develop regional and national centers of excellence with combined clinical expertise and ongoing research protocols in motility disorders and functional bowel disorders.