Pediatric Gastroenterology, Hepatology and Nutrition

Pediatric Gastroenterology, Hepatology and Nutrition is a specialty that deals with the diagnosis and treatment of digestive system diseases in children presenting with complaints such as recurrent vomiting, recurrent abdominal pain, indigestion, bloating, heartburn and chest pain, chronic diarrhea, constipation, and upper and lower gastrointestinal bleeding, as well as acute and chronic liver and biliary tract diseases, pancreatic diseases, nutritional disorders and growth retardation.

Which Diseases Does Pediatric Gastroenterology Deal With?

Some of the diseases and complaints that fall within the specialty of Pediatric Gastroenterology, Hepatology and Nutrition can be summarized as follows:

● Nutritional management of healthy and sick children: To ensure normal physical and mental development in infants and children, an adequate and balanced intake of macronutrients such as carbohydrates, fats and proteins, and of micronutrients such as vitamins and minerals, is essential, and any deficiencies must be recognized and treated promptly. Loss of appetite and behavioral feeding disorders are the most important causes of nutritional disorders in children without an organic problem. Chronic diseases (of the liver, kidneys, lungs, nervous system and musculoskeletal system) very often lead to malnutrition and growth retardation when adequate nutritional support is not provided. In such cases, enteral nutritional support may be needed, either orally or through a percutaneous endoscopic gastrostomy (PEG) tube.

● Gastroesophageal reflux disease (GERD): Gastroesophageal reflux disease refers to a condition in which the backflow of stomach contents into the esophagus causes various complaints and complications. In older children, it often causes symptoms such as heartburn, stomach pain and difficulty swallowing. In younger children, it may cause a wider range of symptoms such as food refusal, irritability, poor weight gain, colic, vomiting and chronic cough. In both younger and older children, it may predispose to recurrent upper and lower respiratory tract infections.

● Dysphagia (difficulty swallowing): In children, dysphagia presents as strain and pain during swallowing and may lead to feeding problems. It may be caused by neurological disorders, anatomical abnormalities or reflux.

● Gastritis and peptic ulcer: Gastritis is inflammation of the mucosa lining the stomach, while a peptic ulcer is the formation of sores due to disruption of tissue integrity in the lining of the stomach or duodenum. Although rare in children, these conditions can occur due to causes such as Helicobacter pylori infection or long-term NSAID use. Symptoms include abdominal pain, nausea and sometimes bleeding.

● Chronic abdominal pain: It may have an organic origin related to the gastrointestinal system, liver, spleen or pancreas, or it may develop without an organic cause (functional). For appropriate treatment, an organic cause must be distinguished from a functional disorder.

● Eosinophilic diseases: Eosinophilic diseases are characterized by an abnormal increase in white blood cells called eosinophils in the digestive system. This can cause inflammation and damage in the stomach, intestines or esophagus. Symptoms include abdominal pain, difficulty swallowing, diarrhea and weight loss.

● Celiac disease and malabsorption disorders: Celiac disease is caused by an immune system reaction to a protein called gluten and leads to damage in the small intestine. Malabsorption disorders, on the other hand, are characterized by inadequate digestion or absorption of nutrients in the digestive system.

● Inflammatory bowel disease (IBD): Inflammatory bowel disease is classified into 2 separate subtypes: Crohn's disease and ulcerative colitis. Crohn's disease can affect any part of the digestive tract from the mouth to the anus, while ulcerative colitis affects the large intestine. A small proportion of patients in the IBD group (around 10%) are defined as having 'IBD unclassified'. These diseases cause inflammation and damage to the lining of the intestine and can lead to symptoms such as abdominal pain, diarrhea, weight loss and growth retardation.

● Irritable bowel syndrome: Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain and changes in bowel habits. In children, IBS may be associated with stress, diet and changes in the gut microbiota.

● Chronic diarrhea: Diarrhea is common in children and may be caused by infection, food intolerance, antibiotic use or digestive system diseases. Because chronic diarrhea can lead to dehydration and nutritional disorders and can be life-threatening, it requires careful diagnostic evaluation and treatment.

● Constipation: Constipation is another common digestive problem in children and is usually related to diet, fluid intake or toilet habits. Chronic constipation can cause abdominal pain, loss of appetite and behavioral changes. When it is not treated with the right medication, at the right dose and for the right duration, treatment success is low and the risk of recurrence is high.

● Upper and lower gastrointestinal bleeding: Upper gastrointestinal bleeding presents with vomiting of blood and/or black, tarry stools, while lower gastrointestinal bleeding presents with bright red rectal bleeding. Endoscopy is the most important method for differential diagnosis and treatment.

● Liver/gallbladder disease: In children, diseases of the liver and gallbladder can develop due to congenital abnormalities, infections or metabolic disorders. These diseases can cause symptoms such as elevated liver enzymes, jaundice, abdominal pain and weight loss.

● Fatty liver disease: In children, fatty liver is associated with obesity and metabolic diseases. Over time, this condition can lead to liver damage and liver failure.

● Gallbladder and biliary tract diseases: These may be congenital or acquired. Especially in older children, gallstones and bile duct stones as well as inflammation of the gallbladder are important in the differential diagnosis of acute and chronic abdominal pain.

● Neonatal cholestasis: This is a condition in which more than 15% of the total bilirubin level consists of direct bilirubin, or the direct bilirubin level is higher than 1 mg/dl. It indicates a disorder of bile synthesis or an obstruction/reduced flow anywhere along the path of bile from the liver cell to the small intestine. Urgent and detailed evaluation is mandatory. Depending on the diagnosis, treatment is planned as either surgery or medication.

● Acute and chronic pancreatitis: The causes of acute pancreatitis are very diverse. It can be infectious, traumatic, metabolic or drug-induced. Some cases of acute pancreatitis become recurrent, and some of these progress to chronic pancreatitis. Acute pancreatitis is a cause of severe upper abdominal pain. In chronic pancreatitis, the digestive and endocrine functions of the pancreas are impaired.

What Are the Symptoms of Pediatric Gastroenterological Diseases?

The symptoms of pediatric gastroenterological diseases may vary depending on the type and severity of the disease and the age of the child. The most common symptoms of pediatric gastroenterological diseases are:

● Difficulty swallowing (dysphagia), a feeling of something stuck in the throat, painful swallowing

● Nausea and vomiting

● Abdominal pain

● Diarrhea

● Constipation

● Bloody and/or mucous stools

● Weight loss and growth retardation

● Bloating and gas

● Yellowing of the eyes and skin (jaundice)

● Vomiting blood, rectal bleeding

How Are Pediatric Gastroenterological Diseases Diagnosed?

The diagnosis of pediatric gastroenterological diseases requires a comprehensive evaluation process. The first step is taking a detailed medical history and performing a physical examination. Pediatric gastroenterologists obtain information from the family to understand the child's complaints, when they began, how long they have lasted and how severe they are. During the physical examination, steps such as palpation of the abdomen, examination of the mouth and throat, and inspection of the skin and eyes are performed. After the physical examination, the doctor may request additional tests such as imaging or blood tests. Some of the tests used in the diagnosis of pediatric gastroenterological diseases are:

Laboratory tests: Laboratory tests such as blood, urine and stool tests play an important role in the diagnosis of pediatric gastroenterological diseases. Blood tests are used to assess infection, anemia, inflammation and liver function. Stool tests help detect intestinal infections, parasites, bleeding and malabsorption disorders. Urine tests are used particularly to evaluate kidney and urinary tract problems.
Endoscopy: Endoscopy is a procedure used to directly visualize the inside of the digestive system. Upper gastrointestinal endoscopy allows examination of the esophagus, stomach and duodenum. Colonoscopy is used to examine the large intestine and a short final section of the small intestine. During endoscopy, biopsies can be taken and the tissues examined under a microscope so that a definitive diagnosis can be made. This method is critically important in diagnosing conditions such as inflammatory bowel diseases (IBD), celiac disease and peptic ulcer.
Imaging techniques: Imaging techniques such as ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT) and barium studies are used for the structural and functional evaluation of the digestive organs.
Special tests: In some cases, special tests may be needed to diagnose specific diseases. For example, the tissue transglutaminase antibody (tTG) test is used in the diagnosis of celiac disease. Breath tests may be performed to evaluate lactose intolerance or other food intolerances, or to detect H. pylori. The hydrogen breath test is used to detect small intestinal bacterial overgrowth, while the urea breath test is used to assess the success of H. pylori treatment.
Genetic tests: Genetic tests are performed for certain congenital anomalies. They can help determine the genetic origins of the disease and hereditary risk factors.

How Are Pediatric Gastroenterological Diseases Treated?

The treatment of pediatric gastroenterological diseases is planned by specialist physicians according to the specific type and severity of the disease. Treatment methods may include:

Medication: Medication plays an important role in the management of many gastroenterological diseases. Medicines are used to reduce inflammation, treat infections, control acid production and relieve symptoms. For example, medicines such as corticosteroids, immunomodulators and biological agents may be prescribed for children with inflammatory bowel diseases (IBD).
Diet and nutritional adjustments: Diet and nutritional adjustments are critically important in the treatment of pediatric gastroenterological diseases. Special diets are applied for children with intolerances or allergies to certain foods. For example, children with celiac disease must follow a gluten-free diet.
Lifestyle changes: Lifestyle changes play an important role in the management of pediatric gastroenterological diseases. For conditions such as GERD and IBS, changes such as regulating eating habits, having small and frequent meals, and avoiding fatty and spicy foods are recommended. In addition, adequate fluid intake and regular physical activity can help prevent problems such as constipation.
Surgical interventions: Surgical interventions may be necessary in some gastroenterological diseases. For example, in children with severe inflammatory bowel diseases (IBD), surgery may be needed if there are intestinal obstructions, fistulas or serious bowel damage. When medication is not sufficient for gastroesophageal reflux disease (GERD), surgical procedures such as fundoplication may be performed.

Frequently Asked Questions

Which Tests Are Used in Pediatric Gastroenterology?

One of the most commonly used methods is endoscopy, which allows a detailed examination of the inside of the esophagus, stomach, duodenum and large intestine. In addition, blood tests and stool analyses are frequently used to identify food allergies or intolerances.

Up to What Age Does Pediatric Gastroenterology Treat Children?

The pediatric gastroenterology outpatient clinic mostly serves children and adolescents from birth to 18 years of age. This specialty deals with the diagnosis and treatment of various digestive system problems from infancy through adolescence.

How Is a Pediatric Gastroenterology Examination Performed?

A pediatric gastroenterology examination begins with a detailed review of the child's medical history. This is followed by a thorough systemic examination, with particular attention to the abdomen. If deemed necessary, further evaluations are carried out using laboratory tests or imaging methods.

How Is Endoscopy Performed in Young Children?

In young children, endoscopy is usually performed under general anesthesia so that the child remains comfortable and still during the procedure. The endoscope, a thin and flexible tube, is guided through the mouth into the stomach and small intestine, while the doctor examines the lining of the digestive tract in detail with the help of a camera. In colonoscopy, a colonoscope suited to the child's age and weight is advanced through the anus to examine the entire colon and the last part of the ileum.

How Long Does a Gastroenterology Examination Take?

The duration of a gastroenterology examination may vary depending on the severity of the patient's complaints and the purpose of the examination. Typically, a gastroenterology examination takes about 20 to 30 minutes. During this time, the doctor reviews the patient's medical history, performs a physical examination and, if necessary, requests additional tests or imaging.

Which Departments Refer Patients to Gastroenterology?

Referrals to the gastroenterology department are usually made by pediatricians, pediatric subspecialists, ENT specialists or pediatric surgeons.

Pediatric gastroenterology is an important medical department dealing with congenital and acquired diseases of the digestive system, liver, gallbladder and bile ducts, and pancreas, as well as nutritional disorders in children. Parents whose children have symptoms related to pediatric gastroenterology can start treatment by making an appointment at the pediatric gastroenterology outpatient clinics of hospitals.