Pediatric gastroenterology
Pediatric gastroenterology is a specialized field focused on the diagnosis and treatment of gastrointestinal diseases and disorders in children. Pediatric gastroenterologists are pediatricians who undergo extensive training, including a medical degree, three years of pediatric residency, and an additional three years dedicated to gastrointestinal issues in children. This specialization addresses a variety of conditions, which can range from common issues like gastroenteritis and constipation to more severe problems such as inflammatory bowel diseases and liver disorders.
Children's gastrointestinal health is crucial for their growth and development, as the gastrointestinal tract plays a key role in digestion and nutrient absorption. Pediatric gastroenterologists not only manage clinical symptoms but also consider nutritional needs when developing treatment plans, which may include specialized diets or intravenous feeding in certain cases. They employ techniques like endoscopy to diagnose conditions and may work in collaboration with surgeons for anatomical defects.
Emotional support for both patients and their families is also an essential aspect of care, as gastrointestinal issues can be particularly stressful for parents. As pediatric gastroenterology continues to evolve, advancements in diagnostic and therapeutic techniques improve the ability to care for young patients with gastrointestinal disorders.
Pediatric gastroenterology
Anatomy or system affected: Abdomen, gallbladder, gastrointestinal system, intestines, liver, pancreas, stomach, throat
Definition: The diagnosis and treatment of diseases and disorders of the digestive tract in infants and children.
Science and Profession
The pediatric gastroenterologist is a pediatrician who has received extra training in the diagnosis and treatment of gastrointestinaldiseases and disorders. The full course of training requires a medical degree followed by three years of pediatric residency, plus an additional three years of solely studying children’s gastrointestinal diseases. The six years of postdoctoral training are almost always conducted at a large teaching hospital.
The gastrointestinal tract extends from the mouth to the anus. It is responsible for the ingestion, digestion, and absorption of food and for the elimination of unusable waste from the diet. Its principal parts are the esophagus, the stomach, the small intestine and colon, and the liver, gallbladder, and pancreas.
Children suffer the same wide range of gastrointestinal problems that afflict adults. Each age group, however, has its own special problems. For example, children very rarely have stomach or colon cancer, both relatively common in adults. On the other hand, diarrhea is a very common cause of infant death worldwide but is seldom life-threatening for adults.
Childhood gastrointestinal disease varies widely in its severity, from simple constipation needing only a change in diet to liver disease so severe that the child must undergo a liver transplant to survive. Common problems that a pediatric gastroenterologist might treat include gastroenteritis, constipation, chronic diarrhea, gastroesophageal reflux (especially in infants), and infections such as bacterial dysentery or viral hepatitis. Less common disorders are peptic ulcers, inflammatory bowel diseases (IBDs) such as ulcerative colitis and Crohn’s disease, and malabsorption disorders involving the ability of the intestines to absorb nutrients from digested food.
The liver, gallbladder, and pancreas are abdominal organs that connect directly with the gastrointestinal tract. They are important in the digestion and absorption of food and in the metabolism of the basic sugars, fats, and proteins that are absorbed by the intestines. The diagnosis and treatment of disorders of these organs are part of gastroenterology.
Anatomical defects of the gastrointestinal tract can occur, such as intestinal malformations, obstructions, imperforate anus, and congenital fistulas between the trachea and esophagus. They are generally treated both by the gastroenterologist and by a general or pediatric surgeon, who performs any necessary surgery.
Since the gastrointestinal tract is critical in the digestion and absorption of food, a pediatric gastroenterologist must know much about nutrition. The physician will often prescribe the proper diet for a particular ailment. Occasionally, this program includes parenteral nutrition, in which a patient is fed intravenously with a complex solution of nutrients.
Most of the gastroenterologist’s time is spent in the clinic, examining patients and prescribing medications, or performing procedures such as endoscopy of the stomach or colon. A minority of this specialist’s patients require hospitalization, few of whom will be seriously or terminally ill.
A child’s intestinal disease, especially if serious, can be very stressful for the patient’s parents. The pediatric gastroenterologist must be able to communicate clearly with parents and support them emotionally during the child’s illness.
Diagnostic and Treatment Techniques
Much of the pediatric gastroenterologist’s work involves obtaining a thorough, detailed history of the ailment from the child and parent. Often, skillful questioning will lead to the proper diagnosis and suggest the best treatment. A careful physical examination of the entire child, not simply the abdomen, is also important.
The pediatric gastroenterologist conducts a wide variety of laboratory tests to evaluate the nature and severity of the illness, such as complete blood counts and liver enzyme measurements. Bowel movement specimens often provide important data, such as the presence of blood or infectious bacteria in the intestines.
The pediatric gastroenterologist performs several diagnostic and therapeutic procedures. Flexible endoscopy is the use of a thin, bendable tube of optic fibers to view the interior of the esophagus, stomach, or colon. The physician can obtain biopsies, small samples of gastric or intestinal tissue, through the endoscope and can remove benign intestinal growths called polyps. The gastroenterologist may place a pH probe, a small electrode on a wire, in the esophagus to test acidity levels for periods as long as twenty-four hours. This probe is used to monitor acid reflux from the stomach into the esophagus. This disease, called gastroesophageal reflux, can lead to weight loss, recurrent pneumonia, or a scarred esophagus if left untreated.
Liver transplantation may be necessary when a child suffers irreversible liver failure as a result of severe hepatitis, congenital abnormalities such as biliary atresia (failure of the bile ducts to form properly), or some disorders of the body’s metabolism. The pediatric gastroenterologist is an important member of the transplant team.
Perspective and Prospects
Subspecialties of pediatrics began to be recognized in the middle of the twentieth century. The first organization for pediatricians interested in gastroenterology was formed in the early 1970s.
In adult gastroenterology, diagnostic tools such as endoscopy and therapies such as antirejection medications for transplantation procedures improved rapidly in the last quarter of the twentieth century. Taking advantage of this new knowledge, pediatric gastroenterologists could also accurately diagnose more disorders in their own patients and treat them effectively.
Bibliography
Bishop, Warren P. “Acute Gastroenteritis.” In Nelson Essentials of Pediatrics, edited by Karen J. Marcdante and Waldo E. Nelson. 6th ed., Saunders/Elsevier, 2011.
Cameron, Don. "Fifty Years of Australian Pediatric Gastroenterology." Journal of Gastroenterology & Hepatology, vol. 3, no. 24, Oct. 2009, pp. 75–80.
Cunningham, Carin L., and Gerard A. Banez. Pediatric Gastrointestinal Disorders: Biopsychosocial Assessment and Treatment. Scholars Portal, 2019.
Gershman, George, Mike Thomson, and Marvin Earl Ament. Practical Pediatric Gastrointestinal Endoscopy. 3rd ed., Wiley-Blackwell, 2021.
Walker, W. Allan, et al., eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. 6th ed., B. C. Decker, 2018.
"What is a Pediatric Gastroenterologist?" WebMD, 13 July 2021, www.webmd.com/a-to-z-guides/what-is-a-pediatric-gastroenterologist. Accessed 25 July 2023.