“Our faculty has visited Arab countries and I have personally participated in clinical activities in Dubai. We routinely discuss patients and provide consultations with several of our colleagues in South America and Europe”
Nationwide Children’s Hospital is one of the largest pediatric hospitals and research institutes in the United States. It is consistently ranked as one of America’s top 10 children’s hospitals by U.S. News & World Report, the recognized authority in United States hospital rankings. Carlo Di Lorenzo, MD, is chief of the Division of Pediatric Gastroenterology, Hepatology and Nutrition, and is widely regarded as one of the world’s top experts in diagnosing and treating functional neurogastrointestinal and motility disorders in children. “Hospitals” magazine recently interviewed Dr. Di Lorenzo about his work at Nationwide Children’s Hospital.
What are some uncommon or particularly challenging conditions treated in the motility center at Nationwide Children’s Hospital?
The Motility Center at Nationwide Children’s Hospital evaluates and treats children and adolescents with any type of motility or functional gastrointestinal disorder. Some of the most challenging diseases for which the Motility Center has developed unique and innovative expertise include:
Pediatric intestinal pseudo-obstruction (PIPO): This is a condition in which the gastrointestinal tract has such poor motility that the child is often not able to eat by mouth and needs tube feeding or parenteral nutrition. Testing in our center helps determine what areas of the intestine are affected by the disease, if there is a nerve or a muscle disease, and how to direct medical and surgical treatment
Gastroparesis: Children with gastroparesis often have severe nausea, vomiting and early satiety. Our Motility Center offers innovative treatments for this condition such as gastric electrical stimulation, injection of botulinum toxin and pylorus and pyloric dilatation
Rumination syndrome: This is a disorder which is being recognized with increased frequency in children of any age. The Motility Center offers the only multidisciplinary treatment to this condition in both the outpatient and in-hospital setting
Post-surgical defecation disorders: Patients who have had surgery for Hirschsprung disease or anorectal malformations often continue to struggle with symptoms even after surgery. The Motility Center is part of the Center for Colorectal and Pelvic Reconstruction and collaborates with several other specialists to diagnose and treat, with innovative technologies, the anatomical or physiological problems that are responsible for the child’s symptoms.
What are the different disciplines involved in diagnosing and treating motility disorders in children?
We have a diverse team of experts representing the key disciplines. These include pediatric and adult gastroenterologists, colorectal and general surgeons, urologists, interventional radiologists, otorhinolaryngologists, dietitians, psychologists, psychiatrists, occupational and speech therapists. They are all part of the Motility Center. We meet weekly to discuss those patients referred to the center and determine our best approach to treatment.
What are some of the latest advancements in treating children with motility disorders?
Several new medications with the potential of improving motility and sensory function of the gastrointestinal tract have been developed in the past 10 years. We have also discovered that some medications which were initially used to treat different diseases (infections, myasthenia gravis, acromegaly, spasticity, etc.) have a beneficial effect on gastrointestinal motility.
Neurostimulation of different areas of the intestine has also shown great promise in improving symptoms of children with nausea, abdominal pain and constipation. Surgical interventions, albeit a last-resort treatment, are now being tailored to each patient based on the radiological and manometric tests that we use to determine how a patient’s gastrointestinal tract is functioning.
How have you been involved with international outreach over the past few years?
Our faculty has visited Arab countries and I have personally participated in clinical activities in Dubai. We routinely discuss patients and provide consultations with several of our colleagues in South America and Europe. Patients from 12 different countries have been referred to our center and have been evaluated by our team.
Do you or members of your faculty take part in international research collaborations?
We have a long-standing and very fruitful collaboration with Emma Children’s Hospital, in Amsterdam, the Netherlands, with exchange of visiting scholars, which has produced more than 40 peer-review publications in the past 15 years. Currently we have ongoing research collaborations with researchers in Italy, the Netherlands, United Kingdom, Australia, Argentina and several other countries. We value those relationships and hope to expand them in the coming years.