Pediatric Gastroenterology

Pediatric gastroenterologists have the training to treat children who have digestive, hepatic, or nutritional issues. It's crucial to have experience and specialized training in pediatric gastroenterology. Children frequently experience different digestive, hepatic, and nutritional issues than adults.

Pediatric gastroenterologists treat from infancy through adolescence. In particular, they make pediatric care the core of their medical practice, providing extensive experience in the care of infants, children, and young people. (1)

Definition and Overview

Pediatric gastroenterologists are medical professionals who have completed specialized training in the diagnosis and management of gastrointestinal (digestive) system diseases in children. These illnesses include issues with the rectum, anus, liver, gallbladder, pancreas, stomach, intestines, and liver. 

Pediatric gastroenterologists additionally deal with cases of malnutrition, failure to thrive, obesity, and problems with feeding and swallowing in children. 

Pediatric gastroenterologists are experienced in treating:

• Irritable bowel syndrome
• Crohn's disease
• Gastroesophageal reflux disease
• Pancreatitis
• Cystic fibrosis
• Gastrointestinal bleeding
• Stomach ache
• Ongoing diarrhea or constipation
• Vomiting
• Lactose intolerance 
• Food allergies or intolerances
• Chronic constipation 
• Chronic or severe diarrhea 
• Pancreatic insufficiency (including cystic fibrosis) and pancreatitis 
• Nutritional problems
• Feeding disorders (2,3)

Procedures

There are various pediatric gastroenterology procedures that can be performed on children to diagnose and treat the conditions. These procedures are determined depending on the child’s overall health, medical history, and doctor’s recommendations. Some of the most common procedures can be listed as:

• Upper endoscopy

During this test, an upper endoscopy is performed, and a small amount of the first part of the small intestine is taken for enzyme analysis. 

• Colonoscopy

The entire length of the big intestine is examined during a colonoscopy. It can aid in reducing bleeding, sores, ulcers, and abnormal growths in tissue. It makes use of a colonoscope, a lengthy, flexible, and illuminated tube. The child's rectum is entered through the colon using the tube. This tube enables the medical professional to examine the colon's lining and collect a biopsy or tissue sample for analysis. For testing, the digestive tract may also be subjected to tissue sampling or biopsies.

• Sigmoidoscopy

With the help of this test, a medical expert can examine the sigmoid and rectum portions of the large intestine on the inside. The large intestine is reached by inserting a sigmoidoscope, a short, fTo inflate the intestine, air is blown through this tube. This tube blows air into the intestine to inflate it. This facilitates seeing inside. If required, a biopsy can be performed.

• Anorectal manometry

The test measures the anus's muscle and nerve reflex strength. Additionally, it examines the child's capacity to sense when the rectum is full and requires a bowel movement (rectal distension) as well as the efficiency with which the muscles cooperate during a bowel movement.

• ERCP (endoscopic retrograde cholangiopancreatography)

This procedure is used to identify and address issues with the pancreas, liver, gallbladder, and bile ducts. It makes use of X-rays and an endoscope, a long, flexible, illuminated tube. The duodenum, the first segment of the small intestine, is reached by the tube. Through the tube, a dye is delivered into the bile ducts. With the use of equipment, the dye can be used to drain fluid, clear obstructions, and remove gallstones from the bile ducts so they can be seen clearly on X-rays. (4)

Candidates

Children show some symptoms and indicate that they have a condition. Those with the following symptoms should be referred by their parents to a pediatric gastroenterologist. These symptoms include:

• Extreme weight loss
• Ongoing diarrhea
• Vomiting
• Constipation
• Bloating and gas
• Thin bones
• Loss of muscle mass
• Changes in tooth enamel
• Chest and abdominal pain
• Painful burning sensation in the chest
• Problems with swallowing
• Respiratory problems
• Irritability
• Problems with growth
• Loss of appetite
• Fever and exhaustion
• Diarrhea with blood and mucus (5)

Risk and Side Effects

Pediatric gastroenterology procedures carry some risks and side effects, however, it's highly important to note that these vary depending on the procedure performed and the individual child's health condition. Some of the common ones include:

• a hole made in the intestinal wall, 
• excessive bleeding, 
• problems from the medications, 
• infections,
• perforation or injury to organs
• adverse reactions to sedation or anesthesia
• a tear in the lining of the duodenum, esophagus, or stomach (6,7)

Post-Procedure and Follow-up

The child will be watched in a recovery area following the procedure until they have fully recovered from the sedative or anesthetic. During this period, it is carefully observed that vital signs including heart rate, blood pressure, and oxygen levels are normal. There may be some blood in the child's stool for a day or so, and this is normal. 

Follow-up visits with the child's pediatric gastroenterologist are usually scheduled to evaluate the status of the child's recovery and go over any potential future management or treatment options. These visits are crucial for keeping track of the child's health, resolving any worries, and making sure the child is receiving the right kind of treatment moving forward.

Recovery

Depending on the precise treatment carried out, the child's age, general health, and the type of gastrointestinal issue being treated, the period of recovery after a pediatric gastroenterology procedure may differ.

The child can feel discomfort from the gas left over from the test in the intestine and this will pass over time as the child comes out. However, if the child has abdominal pain lasting more than an hour, a large and hard abdomen, bleeding, continued bleeding on the second day, fever, or recurrent vomiting, the parent should call the doctor immediately or medical support should be sought.

Results

The caregivers have to strictly adhere to the doctor's recommendations and get help right away if any problems or alarming symptoms occur while the patient is recovering. Since every child's recuperation is different, the healthcare practitioner will offer specialized advice depending on the particular treatment and the child's specific needs.