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Pediatric Gastroenterology
Pediatric Gastroenterology is a subspecialty branch of general paediatrics, the branch cover gastrointestinal (stomach and intestines), liver and metabolic diseases of pediatric age patient (0-18 years).
If your child has digestive systems, liver or nutritional problem, a pediatric gastroenterologist has the expertise to treat your child.
Digestive, liver and nutritional problems in children often are quite different from those seen in adults. Specialized training and experience in pediatric gastroenterology are important.
Children are not just small adults. Their bodies are growing and have unique medical needs. They usually express their concerns differently than adults. They cannot always answer medical questions and are not always able to be patient and cooperative. We as pediatric gastroenterologists know how to examine and treat children in a way that makes them relaxed and cooperative. We focus on problems unique to pediatric patients, including growth, maturation, physical and emotional development and age- related social issues. We as a team at Sir Ganga Ram Hospital are dedicated towards gastroenterology, liver and metabolic diseases of children. We provide expert care for both common and complex gastrointestinal disorders in children.
Common Gastroenterology and hepatology diseases which are commonly encountered in children are:
Recurrent Abdominal Pain
Recurrent abdominal pain is one of the commonest gastrointestinal complaints in children, affecting approximately 10% of school aged children and adolescents. Recurrent Abdominal Pain Syndrome in Children (RAP) is a common cause of repeated episodes of belly pain in otherwise healthy children. It is a common cause for missing school and other activities. Common symptoms of RAP include: Repeated episodes of belly pain – usually around the belly button. Pain that lasts 1 to 3 hours, the child often lies down with the belly pain. After the pain subsides, the child acts normally. The causes can be related to stomach, pancreas, liver, Gall bladder, infection and infestations, food allergy, urinary tract and other miscellaneous causes. A detailed history and examination is needed to ascertain the causes, few investigations are also needed to diagnose the cause of pain in child.
Failure to Thrive
Failure to Thrive (FTT) is a condition in a baby or child that related to the child failure to grow (Mentally, Physically or emotionally). It also relates to gains in height and weight ad expected for the child’s age. It usually is noticed from infancy to the age of five. When the child is far below normal height and weight gains for his/her age, he or she should be evaluated medically, physically and psychologically. However a child may be growing at a normal rate but be short in stature due to heredity. There may be a normal delay in growth that usually catches up with their peers at puberty or afterward. There can be variety of causes for FTT which need to be addressed to cure the kid.
Recurrent Vomiting
All children vomit from time to time, but frequent vomiting should be taken more seriously, recurrent vomiting have various causes like Gastro esophageal reflux- Gastro esophageal reflux (GER) occurs when stomach contents come back up into the esophagus, (the tube that connects the mouth to the stomach) this usually happens during or after a meal.
Constipation
Constipation is a condition in which bowel movements occur less frequently than usual or stools tend to be hard, dry and difficult and painful to pass. It is a life style diseases and very common in children and is usually without long-term consequences; however, it can diminish a child’s quality of life, causing emotional problems, and create family stress. Rarely, constipation is a sign of a more serious health problem. Constipation occurs commonly in children, affection up to 10% at any given time. Still only 3% of parents actually seek advice from the doctor for the condition.
Acute Pain Abdomen
It is one the most common presentation for which a child approaches a medical facility, pain abdomen can have various etiologies which vary according to site, severity, location, radiation etc. Some causes needed urgent surgical interventions like acute appendicitis, perforation etc and some cause can be managed conservatively. If a child has acute pain abdomen, a detailed evaluation is needed to assess the cause and to plan the future management.
Foreign Body Ingestion
As children explore and interact with the world, they will put foreign bodies into their mouths and swallow some of them. Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Foreign bodies that damage the GI tract, become lodged, or have associated toxicity must be identified and removed. Children with pre-existing GI abnormalities (eg, tracheoesophageal fistula, stenosing lesions and previous GI surgery) are at an increased risk for complications. The foreign body may vary from nuts, metal clips fish bone and what not. Foreign body are removed by a endocosopic procedure, which is done after giving a sedation to the child and by a endoscopy the foreign body can be easily removed.
Bleeding from Rectum / Blood in Stool
Passage of blood in stool in children have various etiologies, it can be due to a fissure which is made by passage of painful hard stool, other causes can vary from colitis, rectal polyp, meckel’s diverticulum with bleeding, vascular malformation of intestine, inflammatory bowel disease ect. A detailed history, examination and reliable investigation are needed to ascertain the causes. The investigations may include few blood tests, stool test, imaging test and endoscopy.
Food Allergies or Intolerances
Food allergy occurs when the body reacts to certain proteins found in food. In the most common type of food allergy, the immune system creates chemicals usually made to fight germs (antibodies). These chemicals cause problems when the protein is eaten.. It may be more common in families with other allergic problems. Any food can cause allergies but the most common ones are:
- Milk
- Eggs
- Peanuts
- Wheat
- Tree nuts ( Such as almonds, walnuts, hazelnuts and pecans)
- Fish (such as bass, flounder and root)
- Shellfish (Such as crab, lobster, and shrimp)
- Soybeans
Acute Diarrhoea and Vomiting
Vomiting (throwing up) and diarrhea (frequent, watery bowel movements) can be caused by viruses, bacteria, parasites, foods that are hard to digest (such as too many sweets) and food such as meat or fish that is undercooked (still partially raw). Vomiting and diarrhea can be harmful because they can cause dehydraton. Dehydration occurs when too much fluid is lost from the body.
Chronic Diarrhea
It is defined when the diarrhea last for > 14 days, chronic diarrhea as several adverse effects on the child’s health like malnutrition, dehydration and so on. The causes of chronic diarrhea very from various infectious causes, malabsorption like celiac disease, congenital disease, etc. A detailed history, examination and investigation are needed to diagnoses the causes and specific disease oriented management to be initiated.
Celiac Disease
Celiac disease is a digestive disease that causes our body’s natural defence system (immune system) to react against its own cells. It interferes with taking in (absorbing) nutrients from food. People who have celiac disease cannot tolerate gluten. Gluten is a protein found in wheat, rye and barley. With time, celiac disease will damage the cells lining the small intestine. This leads to being unable to absorb nutrients from food (malabsorption), diarrhea and nutritional problems. Celiac disease has a genetic predisposition this means you have a higher likelihood of getting the disease if someone in your family has or had it. Up to 10% of one’s close relatives (parent, sibling, and child) may also have the disease.
Obesity
Children’s weight affects their health. A child is considered overweight when his or her BMI is higher than the BMI of 85 percent of boys or girls of the same age. A child is considered obese when his or her BMI is higher than the BMI of 95 Percent of boys or girls or the same age. Obesity is a serious health concern. Children who are obese are more likely than other children to have a disease that causes breathing problems (asthma). Obese children often have skin problems. They are apt to develop a disease in which there is too much sugar in the blood (diabetes). Heart problems can occur. So can high blood pressure. Obese children may have trouble sleeping and can suffer from some orthopaedic problems from their weight. Some have problems with school work. Your child’s diet will probably have to change and he or she will probably need to become more active. But helping a child lose weight can save the child’s life.
Blood in Vomitus
Blood in vomitus in known as hemetemesis in medical term, it can be a medical emergency and a child should be urgently evaluated at a health care facility. The causes are varied, it can be a secondary to bleeding gastric ulcer, due to drugs like pain killers, due to swallowing to blood from nasal bleeding. The management will depend on the cause, and detailed evolution is needed to ascertain the cause.
Jaundice
Jaundice is yellowish discoloration of the skin, whites of the eyes (sclera) and mucus membranes. It is caused by increased levels of bilirubin in the blood (hyperbilirubinemia). Bilirubin is a normal by – product of the breakdown of red blood cells. Bilirubin is normally removed by the kidneys. High levels of it cause the urine to turn dark. Most of the time jaundice means the liver or bile system is not working normally. Less Often, Jaundice happens due to a problem that includes damage to normal red blood cells. A detailed history, examination and evaluation is needed the common causes are like acute viral hepatitis, biliary tract diseases etc.
Liver Transplantation (LT)
The liver is an important organ in the upper abdomen. It helps fight infections and digest food, cleans the blood and stores nutrients. Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one. Its used for end-stage liver disease (ESLD), acute fulminant liver failure, etc. Whole liver come from people who have died (cadaveric donor). Healthy living donors (usually family members) can also donate part of their liver. This can be done because the liver can re-grow to normal size. All livers are tested before surgery. Tests Make sure that the liver is healthy, the right size, and the blood types match. The surgeon disconnects the diseased liver from bile ducts and blood vessels. The surgeon then puts in the healthy liver and reconnects it. Liver transplantation has had a profound impact on the care of patients with end-stage liver disease and FHF and is the most effective treatment of many patients with acute or chronic liver failure resulting from a variety of causes. Before transplantation, patients with advanced liver disease usually die within months to years. These patients now have the opportunity for extended survival with excellent quality of life after liver transplantations . Till a few years back in the absence of LT facilities in India, a transplant. Receiving a liver transplant in the west was not only a costly exercise but also entailed a log waiting period as being a foreigner, he/she would get a low priority on the cadaver waiting lists which were understandably biased to favour the state health entitled native population.
