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Addressing Complex Esophageal and Anorectal Disorders in Children

NEW YORK (May 1, 2013)

The Pediatric Motility Center at NewYork-Presbyterian Phyllis and David Komansky Center for Children's Health/Weill Cornell Medical Center offers special expertise in esophageal and anorectal disorders in children. The Pediatric Motility Center, established in 2011, is one of only a few pediatric motility programs in the country, and the only one in the New York metropolitan region, to provide motility studies in infants, children, and adolescents.

Thomas Ciecierega, M.D.
Thomas Ciecierega, M.D.

Motility refers to the movement of the gastrointestinal tract involving a complex interaction of the gut, nerves, and the brain. Pediatric gastrointestinal motility disorders are common and can range from relatively benign conditions such as constipation and gastroesophageal reflux (GER) to very serious diseases such as Hirschsprung's disease, where there is a lack of innervation to the distal part of gastrointestinal tract, or esophageal atresia, a congenital condition that results in interruption of the esophagus.

"Esophageal disorders are common and include problems involving difficulty in swallowing and gastroesophageal reflux disease. They are always present in children with congenital abnormalities," says Thomas Ciecierega, M.D., pediatric gastroenterologist and Director of the Pediatric Motility Center. "Some children may be born with esophageal atresia, a break in their 'food pipe,' and have abnormal anatomical connections or strictures. These problems tend to be very complex and these children should be followed by a specialized motility center such as ours."

A child born with esophageal atresia will require surgery to reconnect the two ends of the esophagus. Dr. Ciecierega works in collaboration with surgeons Rasa Zarengar, M.D., and Oliver Muensterer, M.D., at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

"Pediatric gastroenterologists manage issues related to surgery," notes Dr. Ciecierega, who is also Director of Pediatric Endoscopy and specializes in advanced endoscopic procedures. "The esophagus can be reconnected, but the way it functions and the development of strictures as the child grows must be addressed by a gastroenterologist. These are complex operations. In addition, our center provides a dietician to counsel the children on appropriate nutrition and a speech pathologist to help advance their oral skills. Each one of these children, no matter what their problem, requires an expert team to manage their care until adulthood."

Achalasia is an esophageal motility disorder in which the main symptoms are dysphasia (swallowing difficulty), regurgitation of undigested food, and chest pain. Patients are referred to the Pediatric Motility Center from the tri-sate area and beyond. "Our program offers a comprehensive approach, including diagnosis, treatment and close follow-up," says Dr. Ciecierega.

The Pediatric Motility Center also treats patients with anorectal disorders, including cloacal malformation, VACTERL Syndrome, Hirschsprung's disease, and constipation. A cloacal malformation is a complex congenital problem defined by a coming together of the urinary tract, vagina, and rectum to form a single common channel, refered to as a cloaca. The goals of treatment include anatomic reconstruction and achieving bowel and urinary control, as well as normal sexual function. "Our center collaborates closely with Dr. Dix Poppas, a pediatric urologist, and Dr. Nitsana Spigland, a pediatric surgeon, to care for children with this very challenging disorder," says Dr. Ciecierega. VACTERL Syndrome encompasses abnormalities in various body systems, including vertebrae (V), anus (A), cardiac (C), trachea (T), esophagus (E), renal system (R), and limb defects (L). "There are many overlapping problems, including frequently the lack of the anal sphincter," says Dr. Ciecierega. "A team approach must be taken to address all of the body's affected systems, including creating an opening for the stool to pass."

Dr. Ciecierega also specializes in treatment-resistant constipation. "We care for a number of children who failed treatments by other specialists. We can implement sophisticated testing, medical treatment, biofeedback, and behavioral modifications," says Dr. Ciecierega.

For more information on the Pediatric Motility Center or to make an appointment, please call (646) 962-3869.

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