HJAR Nov/Dec 2024

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2024 41 John Rosen, MD Medical Director Director of Neurogastroenterology and Motility Arkansas Children’s Northwest determination of gastro-esophageal junc- tion distensibility while under anesthe- sia. This information aids in determining the next diagnostic and treatment steps for children with difficulty swallowing or chronic esophageal diseases like eosino- philic esophagitis. Improving diagnostic accuracy ultimately prevents unnecessary treatments, saving pa- tients and their caregivers time and money. Manometry and EndoFLIP are often done in conjunction with endoscopy, optimizing patient and provider time. For example, if a preschooler with autism is refusing food, endoscopy can be used to identify inflam- mation, and EndoFLIP can screen for motor dysfunction, all while the patient is sedated and comfortable. We couldn’t accomplish that if the patient was awake. Manometry and EndoFLIP complement the list of GI services for children already available in Arkansas, including these ad- vanced endoscopic procedures: • Unsedated transnasal endoscopies. • Endoscopic retrograde cholangiopancreatography. • SpyGlass cholangioscopy. • Video capsule endoscopies. • Electrohydraulic lithotripsies. • Endoscopic balloon dilations. • Gastrointestinal sphincter botulinum toxin injections. • Push and single balloon enteroscopy. DGBI management Research indicates a treatment plan de- signed around multidisciplinary, integrated care produces the most effective outcomes for DGBI patients. Collaboration between primary care pro- viders, gastroenterologists, psychologists, and dietitians allows for the combination of medical therapies with dietary interventions and psychological treatments. Disorders of gut-brain interaction are the result of the interplay between physiological, psycho- logical, and environmental factors; therefore, effective therapies include: • Targeting gut physiology, including sensation and motor function. • Addressing sources of stress and anxi- ety with relaxation training, mindful- ness, cognitive behavior therapy, and gut-directed hypnotherapy. • Recommending regular exercise, healthy sleep, and other self-manage- ment strategies. • Preferencing non-opioid over-the- counter, prescription, and alternative medications, including neuromodula- tors that target central pain processing pathways. • Regular check-ins and ongoing support from healthcare providers. Arkansas, a regional resource Arkansas has invested in the infrastruc- ture necessary to make telehealth a viable and effective tool. It is especially useful for the diagnosis and management of DGBI be- cause so much of our work involves con- sulting with primary care clinicians; inter- viewing patients about symptoms, including abdominal pain and bowel movements; ana- lyzing test results; and developing a treat- ment plan — most of which we accomplish remotely, saving patients and caregivers the burden of traveling to a hospital or clinic. Together, we can ensure the children of Arkansas and the surrounding states receive the care they deserve by building awareness of these resources and strengthening col- laborative efforts. n John Rosen, MD, is a pediatric gastroenterologist and director of neurogastroenterology and motility atArkansas Children’s Northwest and a professor of pediatric gastroenterology at the University ofArkan- sas for Medical Sciences. (pelvic floor and other physical or occupa- tional therapy), schools, and psychotherapy, specifically pediatric psychology. Understanding DGBI Use of the term “disorders of gut-brain in- teraction”provides a clearer representation of the complex communication between the gut and the brain. DGBI more accurately de- scribes the altered communication between the enteric and central nervous systems. A neurogastroenterology and motility (NGM) sub-specialist focuses on those systems and the bi-directional communication between them, including coordination of the muscles that move food through the digestive tract. Although testing is generally limited in the diagnosis and treatment of DGBIs, if diagno- sis may instead represent an intestinal mo- tor disorder, the NGM program at Arkansas Children’s uses manometry and EndoFLIP (endoluminal functional lumen imaging probe) to improve clarity. Both procedures use catheters to measure motor function in the GI tract. EndoFLIP measures the di- ameter of the esophagus as a surrogate for pressure or strength, whereas manometry directly measures the strength and patterns of muscle contractions. Manometry in the esophagus is instru- mental in diagnosing achalasia and deter- mining if muscle dysfunction is contribut- ing to swallowing difficulties. Manometry in other parts of the intestine can help diagnose pseudo-obstruction, rule out Hirschsprung disease, and determine strength and coor- dination of muscles used for defecation. It provides information that can guide treat- ment decisions including pharmacologic, surgical, and behavioral strategies. EndoFLIP provides information about the esophagus that barium esophagram and endoscopy cannot, including assess- ment of esophageal motor function and