Devanarayana NM, Rajindrajith S. Gastric motility abnormalities in pediatric gastroesophageal reflux disease: A comprehensive review of mechanisms and therapeutic implications. World J Clin Pediatr 2026; 15(4): 122141 [DOI: 10.5409/wjcp.122141]
Corresponding Author of This Article
Niranga Manjuri Devanarayana, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Devanarayana NM, Rajindrajith S. Gastric motility abnormalities in pediatric gastroesophageal reflux disease: A comprehensive review of mechanisms and therapeutic implications. World J Clin Pediatr 2026; 15(4): 122141 [DOI: 10.5409/wjcp.122141]
Supported by the Research Council Grant of the University of Kelaniya, Sri Lanka, No. RC/2026/PPRP 06.
Conflict-of-interest statement: Both authors report no relevant conflicts of interest for this article.
Corresponding author: Niranga Manjuri Devanarayana, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
Received: April 14, 2026 Revised: June 15, 2026 Accepted: July 13, 2026 Published online: December 9, 2026 Processing time: 158 Days and 19.9 Hours
Abstract
Gastroesophageal reflux disease (GERD) is a common pediatric gastrointestinal disorder associated with significant morbidity, especially when persistent or severe. Although the primary underlying mechanism for GERD is lower esophageal sphincter dysfunction, there is accumulating evidence that disturbances in gastric motility significantly contribute. Described gastric motor abnormalities in GERD include delayed emptying, antral hypomotility, impaired gastric accommodation, abnormal intragastric meal distribution, disordered gastric myoelectrical activity, duodeno-gastro-esophageal reflux, and altered migrating motor complexes. These disturbances are hypothesized to contribute to GERD by increasing intragastric pressure, delaying gastric emptying, and facilitating retrograde flow of gastric contents into the esophagus, acting through complementary mechanisms. The relationship between gastric dysmotility and GERD symptoms remains unclear, leading to uncertainty regarding its clinical significance. Furthermore, there is uncertainty about the role of investigations such as gastric emptying scintigraphy, 13C-breath tests, and advanced motility techniques in routine practice. Therapeutic approaches for correcting motility disturbances, including prokinetic medications and neuromodulation, show promise but have limited evidence for their effectiveness in children. Future research should better delineate the role of gastric dysmotility in GERD, refine indications for gastric motility investigations, and evaluate the benefits of targeted motility-based therapies to optimize management strategies in pediatric GERD.
Core Tip: Gastroesophageal reflux disease (GERD) is common in infants and children and significantly affects their well-being. While lower esophageal sphincter dysfunction is central to its pathophysiology, gastric dysmotility is increasingly recognized as a key contributor. This narrative review examines the relationship between gastric motor dysfunction and pediatric GERD, highlighting associated abnormalities, diagnostic challenges, and therapeutic strategies. Future research should focus on developing safe, non-invasive diagnostic tools and targeted treatments addressing gastric motility disturbances. A deeper understanding of gastric motor dysfunction will help clinicians tailor interventions, improving outcomes and quality of life of affected children.
