Little Patients Big Discoveries: Potential Pediatric to Adult Neurogastroenterology Translation.

Abstract

Pediatric neurogastroenterology conditions, including disorders of gut-brain interaction (DGBI) and motility disorders, affect millions of children worldwide. Due to limited pediatric data, reference ranges and management are often extrapolated from adult studies. We review four pediatric neurogastroenterology areas where clinical science may translate and inform adult gastroenterology. Sucrase-isomaltase deficiency can be diagnosed via disaccharidase enzyme testing from duodenal mucosal biopsies. Dietary restriction and sacrosidase supplementation are effective, based on randomized controlled trials, in children with genetic sucrase-isomaltase deficiency; however, they remain to be rigorously studied in adults. Gastric emptying breath testing (GEBT) in large cohorts of children reinforces the importance of biological sex, puberty, and size while deriving normative reference values. Further study of GEBT in adults may help determine the influence of sex and hormones on gastric emptying rates, offering an opportunity to develop tailored reference ranges. Antegrade continence enema (ACE) therapy is the most common reversible surgical treatment for children with chronic constipation with high rates of efficacy. Few studies have investigated the efficacy of ACE in adult populations. Auricular neurostimulation through percutaneous electrical nerve field stimulation is Food and Drug Administration approved for use in adolescents with irritable bowel syndrome and functional dyspepsia based on sham-controlled, randomized trials with emerging efficacy data in other pediatric DGBI. To date, efficacy studies using auricular neurostimulation in adults with gastrointestinal disorders have not been performed. These areas highlight how pediatric neurogastroenterology generates discoveries with the potential to guide approaches in adult populations, underscoring the bidirectional value of translational clinical science.