Gastric motility abnormalities in pediatric gastroesophageal reflux disease: A comprehensive review of mechanisms and therapeutic implications

Table 2 Gastroprokinetic agents, their mechanisms of action and clinical relevance in pediatric gastroesophageal reflux disease

Drug	Mechanism of action	Effects on gastrointestinal motility	Use in pediatric GERD	Key limitations
Domperidone	D-2 receptor agonist	Increased GE, increased LES tone	Common	QT prolongation
Metoclopramide	D-2 and 5HT4 receptor agonist	Increased GE, increased LES tone	Limited	Neurological side effects
Erythromycin	Motilin receptor agonist	Increased MMC, increased GE	Off label	Tachyphylaxis
Buspirone	5HT1A receptor agonist	Increased gastric accommodation, increased esophageal motility	Emerging	Limited pediatric data
Acotiamide	A muscarinic receptor antagonist	Decreased postprandial symptoms, enhanced accommodation and antral motility	Emerging	Mostly adult data
Camicinal	Small molecular motilin receptor agonist	Increased gastrointestinal motility and GE	Emerging	No pediatric data
Relamorelin	Ghrelin receptor agonist	Increased GE	Emerging	No pediatric data

D-2: Dopamine-2; GE: Gastric emptying; GERD: Gastroesophageal reflux disease; LES: Lower esophageal sphincter; MMC: Migrating motor complexes.