Pediatric Neurogastroenterology and Motility Program

Schedule a Virtual Visit

Our team provides patients with virtual visits using video-based programs over a secure Internet connection to the patient’s desktop computer, laptop or tablet. Virtual visits give our patients and families a direct video link with their doctor without having to travel for an appointment. Patients may discuss symptoms and clarify treatment plans from the comfort of their home or another private setting. To arrange a virtual visit, please call 617-726-0270.

Learn more about virtual visits  

A Comprehensive Care Program

The Pediatric Neurogastroenterology Program at MassGeneral Hospital for Children (MGHfC) is designed to restore nutritional status and improve bowel function in children with a variety of chronic intestinal problems. We provide family-centered care with support and infrastructure for all aspects of the quality of life of our patients. Some of our tailored programs include:

• Bowel Management Program
• Toilet Training Clinic

Your child will receive personalized care as recommended by our team of nutritionists, psychiatrists, and surgeons. Our goal is to provide a multidisciplinary approach that offers you and your child a wide range of expertise in the evaluation and treatment of children with severe intestinal disorders including:

• Anorectal malformations
• Chronic nausea and vomiting
• Esophageal motility disorders
• Gastroparesis
• Hirschsprung’s disease
• Intestinal atresia
• Intestinal neuronal dysplasia
• Intractable constipation
• Irritable bowel syndrome and abdominal pain
• Radiation enteritis

Specialized Diagnostic Procedures

Our Pediatric Motility Laboratory performs a large number of specialized diagnostic procedures for the evaluation of gastrointestinal motility disorders including:

• Esophageal manometry
• Colonic manometry
• Anorectal manometry
• Antroduodenal manometry
• PH studies including wireless pH and pH impedance
• Electrogastrography
• Breath testing

Meet the Team

The Pediatric Neurogastroenterology and Motility program is a collaboration of surgical, psychiatric, and nutritional experts.

Medical/Surgical Staff

• 

  Allan M. Goldstein, MD

  • Chief, Pediatric Surgery
  • Co-Director, Pediatric Neurogastroenterology and Motility Program
• 

  Claire Zar-Kessler, MD

  • Co-Director, Pediatric Neurogastroenterology and Motility Program
• 

  Daniel P. Doody, MD

  • Pediatric Surgery
• 

  Janet Brideau, CPNP

  • Pediatric Gastroenterology and Nutrition
  • Pediatric Neurogastroenterology and Motility Program

Child Psychiatrist

Child Nutritionist

Our Multidisciplinary Team

Each child will be evaluated and cared for by a team of experts, including pediatric surgeons, gastroenterologists, nutritionists and nurses. Child psychiatrists, child life specialists and social workers are also readily available to assist in the care of these young patients. We use state-of-the-art equipment to examine the motility of the intestinal tract. Our team works closely with pathologists and radiologists who are experts in these complex conditions.

In collaboration with the nuclear medicine and radiology departments we perform gastric emptying studies as well as gastrointestinal transit studies, and with pathology department support we go beyond in the analysis of tissue samples, including the role of neurotransmitters and Interstitial Cells of Cajal in gastrointestinal motility disorders in children (including motility disorders caused by Inflammatory Bowel Disease).

We are proud of our strong relationship with the surgical department, a relationship that has enhanced our program, creating a multidisciplinary program for the evaluation of patients with complex gastrointestinal motility disorders designed to restore nutritional status and to improve bowel function in children. This collaborative work allows us to perform a great array of diagnostic and therapeutic procedures including tissue biopsies and novel and specialized surgical procedures for gastrointestinal motility disorders refractory to medical treatment.

We also collaborate with the Pediatric Aerodigestive Center evaluating children suffering with symptoms that affect their ability to eat, breathe or speak.

With greater awareness of gastrointestinal motility disorders in children and new technologies for diagnosing and analyzing such conditions, specialists are gaining in their ability to begin treatment earlier in the course of disease while improving the prognosis for many patients.

Cutting-Edge Research

Members of the Pediatric Neurogastroenterology and Motility Program are actively involved in leading scientific research to better understand the causes of intestinal failure.

Our basic science research program aims to understand the development of the enteric nervous system and how abnormalities of nerve cell development in the intestine lead to Hirschsprung disease, constipation, and other disorders of the intestine.

• Complex Simplicity and Hirschsprung's Disease (2019)
• Hypoganglionosis in the Gastric Antrum Causes Delayed Gastric Emptying (2019)
• Enteric Neuronal Cell Therapy Reverses Architectural Changes in a Novel Diphtheria Toxin-Mediated Model of Colonic Aganglionosis (2019)
• Intraganglionic Macrophages: A New Population of Cells in the Enteric Ganglia (2018)
• Collagen 18 and Agrin Are Secreted by Neural Crest Cells to Remodel Their Microenvironment and Regulate Their Migration During Enteric Nervous System Development (2018)
• Pediatric Enteric Neuropathies: Diagnosis and Current Management (2017)
• Postnatal Human Enteric Neuronal Progenitors Can Migrate, Differentiate, and Proliferate in Embryonic and Postnatal Aganglionic Gut Environments (2017)
• Intestinal Smooth Muscle Is Required for Patterning the Enteric Nervous System (2017)
• Enteric Nervous System Development: A Crest Cell's Journey From Neural Tube to Colon (2017)
• Optimizing Neurogenic Potential of Enteric Neurospheres for Treatment of Neurointestinal Diseases (2016)
• Clinical Aspects of Neurointestinal Disease: Pathophysiology, Diagnosis, and Treatment (2016)
• Colitis Induces Enteric Neurogenesis Through a 5-HT4-dependent Mechanism (2015)
• Sonic Hedgehog Controls Enteric Nervous System Development by Patterning the Extracellular Matrix (2015)
• Presence of Intramucosal Neuroglial Cells in Normal and Aganglionic Human Colon (2014)
• Immunophenotypic Characterization of Enteric Neural Crest Cells in the Developing Avian Colorectum (2012)
• Gdnf Is Mitogenic, Neurotrophic, and Chemoattractive to Enteric Neural Crest Cells in the Embryonic Colon (2011)
• Endothelial Cells Promote Migration and Proliferation of Enteric Neural Crest Cells via beta1 Integrin Signaling (2009)
• A Bird's Eye View of Enteric Nervous System Development: Lessons From the Avian Embryo (2008)
• Endothelin-3 Regulates Neural Crest Cell Proliferation and Differentiation in the Hindgut Enteric Nervous System (2006)

We perform clinical research studies to understand the natural history, diagnosis, and treatment of motility disorders including gastroparesis, intestinal pseudo-obstruction and intractable constipation.

• Pan-enteric Neuropathy and Dysmotility Are Present in a Mouse Model of Short-Segment Hirschsprung Disease and May Contribute to Post-Pullthrough Morbidity (2020)
• Guidelines for Synoptic Reporting of Surgery and Pathology in Hirschsprung Disease (2019)
• Benefit of Pelvic Floor Physical Therapy in Pediatric Patients With Dyssynergic Defecation Constipation (2019)
• Surgical Management of Idiopathic Constipation in Pediatric Patients (2018)
• Transitions in Care From Pediatric to Adult General Surgery: Evaluating an Unmet Need for Patients With Anorectal Malformation and Hirschsprung Disease (2018)
• Botulinum Toxin Injection for Childhood Constipation Is Safe and Can Be Effective Regardless of Anal Sphincter Dynamics (2018)
• Colitis Promotes Neuronal Differentiation of Sox2+ and PLP1+ Enteric Cells (2017)
• Guidelines for the Management of Postoperative Obstructive Symptoms in Children With Hirschsprung Disease (2017)
• Treatment of Functional Abdominal Pain With Antidepressants: Benefits, Adverse Effects, and the Gastroenterologist's Role (2017)
• Bowel Dysfunction Following Pullthrough Surgery Is Associated With an Overabundance of Nitrergic Neurons in Hirschsprung Disease (2016)
• Need for Rectal Biopsy for Childhood Constipation Predicts Severity of Illness and Need for Laxatives (2016)
• Bear-down Maneuver Is a Useful Adjunct in the Evaluation of Children With Chronic Constipation (2013)
• Balloon Expulsion Test as a Screen for Outlet Obstruction in Children With Chronic Constipation (2013)
• Clinical Presentation, Response to Therapy, and Outcome of Gastroparesis in Children (2012)
• Intestinal Malrotation: Varied Clinical Presentation From Infancy Through Adulthood (2011)
• Laparoscopic-assisted Percutaneous Endoscopic Cecostomy in Children With Defecation Disorders (With Video) (2011)

• Antegrade Colonic Enemas and Intestinal Diversion Are Highly Effective in the Management of Children With Intractable Constipation (2010)
• Botulinum Toxin for the Treatment of Chronic Constipation in Children With Internal Anal Sphincter Dysfunction (2008)

We are developing methods to isolate and transplant neuronal stem cells in order to replace missing or damaged nerve cells in the intestine for the treatment of intestinal neuropathies.

• Bioengineering of Functional Human Induced Pluripotent Stem Cell-Derived Intestinal Grafts (2017)
• Delivery of Enteric Neural Progenitors With 5-HT4 Agonist-Loaded Nanoparticles and Thermosensitive Hydrogel Enhances Cell Proliferation and Differentiation Following Transplantation in Vivo (2016)
• Enteric Neural Crest-Derived Cells Promote Their Migration by Modifying Their Microenvironment Through tenascin-C Production (2013)

Using metabolite profiling, we are working to identify novel serum biomarkers associated with colonic contractility and constipation in children.

• Goldstein Lab: Allan Goldstein, MD

Using a genetic mouse model, we are studying the causes of Hirschsprung’s-associated enterocolitis in order to develop methods to prevent this serious condition.

• Microbiome Composition in Both Wild-Type and Disease Model Mice Is Heavily Influenced by Mouse Facility (2018)
• Guidelines for the Diagnosis and Management of Hirschsprung-associated Enterocolitis (2017)
• Altered Goblet Cell Differentiation and Surface Mucus Properties in Hirschsprung Disease (2014)

We are exploring novel minimally invasive technologies that will enable us to use colonoscopy and laparoscopy to visualize nerve cells in the intestine without the need for rectal or colonic biopsies.

• Full-field Optical Coherence Microscopy Is a Novel Technique for Imaging Enteric Ganglia in the Gastrointestinal Tract (2012)