New treatments help kids with chronic stomach pain

Imagine that your 11-year-old daughter or granddaughter, once a bubbly, active little girl, is crippled with chronic stomach pain. The family has tried everything—nothing is working. Where do you go?

Not long ago, you wouldn’t have had many options. In 1998, I was a junior faculty member at Cincinnati Children’s Hospital Medical Center (CCHMC) where I observed that there was a significant increase in new knowledge and technology in the field of neurogastroenterology—but these were focused primarily in diagnosing and treating adults.

With the help of a nurse, I started a pediatric neurogastroenterology center at CCHMC, one of the very few of its kind. Today it’s among the top three in the nation, with nine nurses, five doctors, and patients from 30 different states and around the world.

We use cutting-edge technology to do several diagnostic procedures unique to our field. These include high-resolution manometry, neuromodulation therapies (including IB stim, sacral nerve and gastric electric stimulation), and others.

For kids suffering with gastroparesis—a condition in which the stomach takes too long to empty, causing nausea, vomiting and abdominal pain—gastric electric stimulation can be life-changing. We collaborate with surgeons to implant electrodes in the stomach. The device delivers mild electrical impulses that help relieve the child’s symptoms.

Another unique offering is esophageal manometry, a catheter-based procedure that measures how well the esophagus is working. Doctors pass a small tube with sensors into the child’s nose and down through the esophagus. The tube is connected to a portable manometry cart, and as the child swallows, the changing pressure in the tube makes tracings on a computer for doctors to evaluate.

In the early days, I had a doctoral student in biomedical engineering put together the first manometry equipment. He put it together piecemeal, and it was always falling apart.

Now there are vendors who make and service the machines, and the center has eight of them. Each costs about $120,000—just one example of the financial challenges we face in procuring the latest technology.

Due to the heavy clinical load, there is no protected time to apply for NIH [National Institutes of Health] funding. At this point, besides just one faculty member who is getting small internal grants, any research that we’re doing is on our own time, off hours, and on weekends.

While dreaming of what could be, we also reflect with pride and gratitude at what has been accomplished these two decades. The cards and letters, the grateful parents—that’s what makes it all worthwhile. It’s ultimately about improving the quality of life for all these medically complex children. That’s why I went into medicine, to make a difference.

AJAY KAUL, M.D., is a professor of clinical pediatrics and director of the Neurogastroenterology Center at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. Healthnetwork Foundation has honored Dr. Kaul with one of its 2021 Service Excellence Awards, a $10,000 grant to support the life-changing research he is spearheading.

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