Dr. Jose Garza joined our group in 2013 and has been providing excellent care for children throughout the South with suspected motility disorders. Recently, he gave our group a fabulous update on what’s new in motility.  My notes below may contain errors in transcription and in omission. Along with my notes, I have included some of his slides. His talk had 123 slides; true motilists would be appalled that I haven’t included more of the high resolution tracing slides (though there are a few tomorrow).

Reflux:

• Positioning babies does not improve reflux (related post: Does Positioning Help Infants with Reflux?)
• NICU study of PPIs showed that in patients in which PPIs were continued had more trouble clearing reflux boluses than in children taken off PPIs
• PPIs may worsen oropharyngeal sensory mechanisms in infants
• Related post: Arching in Infants Not Due to Reflux

Colic:

• Colic may be a biorhythm disorder. Infants with colic sleep less and have family history with much higher rates of maternal migraines (related post: Is Infantile Colic a Biorhythm Disorder?)

BRUE:

• 1 of 4 infants with GERD symptoms have oromotor discoordination (related post: Incredible Review of GERD, BRUE, Aspiration, and Gastroparesis)
• BRUE likely related to oromotor discoordination rather than GERD (related post: Blaming Reflux for BRUEs -Not Changing Despite Guideline Recommendations)

Laryngomalacia/Thickening:

• Thickening helps reduce symptoms and hospitalizations
• Thickening can be tricky. Hard to thicken breastmilk and elemental formulas
• IDDSI 10 mL Syringe Flow testing can determine if thickening is at desired level
• Related post: Acid Suppression for Laryngomalacia -Handed This Article to My ENT Colleagues

Impedance

• Predicts mucosal disease in the esophagus (and airway) (related post: Understanding Reflux/Airway Disease and Potential Role of Airway Impedance)
• In adults, but not pediatrics, balloon-based impedance technology  has been useful in distinguishing GERD, EoE from normal mucosa

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