Pediatric gastrointestinal disease

Overview

Functional difficulties such as frequent or persistent stomach discomfort, reflux symptoms, irritable bowel syndrome (IBS), and constipation are common gastrointestinal complaints in children. There are several ways to assist the kid feel better, and the process begins with the child and parents recognizing the diagnosis and realizing that, while the pain is genuine and frequently great, it is a "safe" condition to have.

What is Pediatric Gastrointestinal Disease? 

A digestive disorder is a gastrointestinal health concern. These problems can interfere with daily functioning and have an impact on child development. Pediatricians and gastroenterologists at Main Health treat children with a variety of digestive diseases, including:

• Abdominal pain
• Celiac disease
• Colitis
• Constipation
• Crohn’s disease
• Esophagitis
• Feeding problems, or failure to thrive
• Food allergies
• Gallbladder diseases
• Gastrointestinal bleeding
• Gastroparesis
• GERD, or gastroesophageal reflux disease
• Hirschsprung’s disease
• Irritable bowel syndrome
• Inflammatory bowel disease
• Intestinal pseudo-obstruction
• Liver disease
• Motility disorders
• Pancreatic diseases
• Peptic ulcers
• Polyps
• Obesity
• Short bowel syndrome

Diagnosing Gastrointestinal Disorders in Kids

Diagnosis of gastrointestinal diseases can be challenging and frustrating, in part because many of these conditions exhibit identical symptoms. Physicians are well-versed in identifying pediatric gastrointestinal diseases and in interpreting test results. They organize diagnostic tests and transmit test findings as promptly and effectively as feasible in order to begin therapy as soon as possible. We want your child to feel better as soon as possible!

Comprehensive testing for gastrointestinal problems is available, including the tests described below. Pediatric nurses and other professionals work closely with parents to ensure that their children are as relaxed and comfortable as possible before, during, and after these examinations. 

24-hour pH probe study (requires an overnight hospital stay)

This test is used to determine the presence of gastroesophageal reflux and the frequency of reflux episodes. Through the nose, a thin, flexible tube is inserted into the esophagus. The tip lies slightly above the esophageal sphincter, a muscle at the bottom of the esophagus that opens to enable ingested food and liquids to enter into the stomach, as well as to monitor fluid and acid levels in the esophagus and detect reflux.

Anorectal and esophageal manometry

Two tiny muscles in the anus (the entrance where stool motions exit) serve to regulate bowel movements. These muscles are generally closed to avoid feces leakage. These muscles must both open at the same moment in order to make a bowel movement. Anorectal manometry is a test that determines how well these muscles perform.

During the test, a balloon-tipped tube will be introduced into the child's rectum, the last segment of the large intestine that finishes at the anus. The balloon will be inflated to various sizes, and the computer will take pressure measurements. The computer will keep track of how the rectum works. During the test, an older kid will be asked to tell the nurse how they are feeling. In addition, the youngster will be urged to press their bottoms shut and push the balloon out. This explains how their bodies regulate their bowel motions.

Antroduodenal manometry

Antroduodenal manometry assesses the capacity of the antrum and duodenum (the first section of the small intestine) to transport digested meals. A tiny catheter with sensors is inserted via the nasal, down the esophagus, and into the stomach and first section of the small intestine for this test, which is usually performed concurrently with an upper endoscopy. Pressure and relaxation measurements are conducted to analyze the motility (movement) of the stomach and duodenum.

Barium swallow

This is a specialized X-ray that can detect liquid reflux into the esophagus, esophageal inflammation, and upper digestive system abnormalities. Your youngster must swallow a little bit of a gritty beverage for the test (barium). This liquid is visible on the X-ray and depicts the swallowing process.

Water-soluble contrast enema

A water-soluble contrast enema is a type of x-ray that examines the anatomy of the large intestine (colon). Your youngster will be given an enema solution containing a water-soluble contrast material to outline the big bowel. A little flexible tube will be inserted into your child's rectum, the last section of the large intestine that terminates at the anus (where bowel movements come out). This tube connects to the enema fluid, which will be injected into the big colon. Before and after your child uses the restroom, an x-ray will be taken. This test is comparable to a barium enema, except that the water-soluble contrast is easier to evacuate than barium.

Breath hydrogen tests

By detecting the quantity of hydrogen in the breath after absorption of sweets or chemicals to identify illness, a breath hydrogen can assist to diagnose improper sugar digestion or the presence of infection. By blowing into a balloon-type bag, a breath sample will be obtained (a face mask will be used for a small child). When bacteria in the intestines breakdown carbohydrates rather than the typical digestive enzymes, or when an infection is present, hydrogen levels rise.

Capsule endoscopy

During this test, a small wireless camera will photograph your child's digestive tract, particularly the lengthy length of the small intestine, which is not visible during an upper endoscopy or colonoscopy. The camera is a big capsule that may be ingested or implanted endoscopically into the patient using a tiny medical device. This test is beneficial to doctors because it allows them to examine regions of the small intestine that other endoscopes cannot.

Colonic manometry

Colonic manometry assesses the colon's (big intestine's) capacity to transport feces. In combination with a colonoscopy, a thin catheter containing sensors is put in the colon for this test. Pressure and relaxation measurements are then obtained for examination of colon motility (movement).

Colonoscopy with Biopsies

An endoscope (or colonoscope), a long, thin tube put via the anus and connected to a video display, allowing the doctor to observe inflammation, bleeding, or ulcers on the colon and small intestine wall (ileum).

Esophageal manometry

Esophageal manometry assesses the esophagus's capacity to transport meals and liquids to the stomach. A small catheter with sensors is placed via the nostril, down into the esophagus, and into the stomach for this test, and pressure and relaxation readings are recorded for analysis.

Flexible sigmoidoscopy

A flexible sigmoidoscopy is a test that allows the doctor to examine the rectum and lower region of the large intestine lining. A flexible tube is inserted into the big bowel through the rectum. The doctor can examine the rectum and large intestine linings and may remove tissue samples to examine under a microscope. This test is normally painless, however the kid may experience some pressure or discomfort.

Hepatobiliary (HIDA) scan 

A hepatobiliary scan is a radiological diagnostic that examines the function of the gallbladder. It is frequently prescribed for complaints of abdominal (stomach) discomfort. For the hepatobiliary scan, your kid will need one or two injections of medication. This will improve the visibility of the liver, gallbladder, and small intestine on x-ray images.

Your child's gastroenterologist may arrange a variety of imaging investigations to pinpoint the source of the problem. These tests may include the barium swallow and an upper GI examination.

Laboratory tests

Your doctor may request blood tests to search for evidence of inflammation, which is common in disorders like inflammatory bowel disease, as well as to screen for anemia and other causes of symptoms, such as infection. Stool tests may also be performed to detect the presence of blood, illness, inflammation, or signs that food is not being properly digested.

Liver biopsy

A biopsy is a test that examines tissue or cells from a specific section of the body. It is possible to do this procedure by cutting or scraping a tiny piece of tissue or by extracting a sample of tissue using a needle and syringe. A little part of the liver is taken with a needle during a liver biopsy and transported to the laboratory for additional examination.

Upper endoscopy with biopsies

Doctors use a tiny fiber-optic camera to look directly into the esophagus, stomach, and first section of the small intestines during this examination, also known as esophagogastroduodenoscopy (EGD). Doctors may also biopsy (remove a tiny sample of) the lining of the esophagus during the surgery to examine for other issues and determine what is causing further difficulties.

Hirschsprung’s disease

Hirschsprung's disease (also known as congenital aganglionic megacolon) happens when part of your baby's intestinal nerve cells (ganglion cells) do not grow properly, causing stool passage through the intestines to be delayed. The gut becomes clogged with feces, causing constipation in your newborn or toddler (unable to have normal bowel movements). A dangerous illness known as enterocolitis can frequently arise, causing fever, discomfort, and diarrhea.

What are the symptoms of Hirschsprung's disease?

The symptoms change with age. Symptoms appear in 80 percent of children with Hirschsprung's disease within the first six weeks of birth. Children with only a short piece of intestine without normal nerve cells, on the other hand, may not develop symptoms for months or years. Constipation is their predominant symptom.

Each child may experience symptoms differently, but common symptoms in infants include:

• Failure to have a bowel movement in the first 48 hours of life
• Abdominal distention (stomach bloating)
• Gradual onset of vomiting
• Fever
• Constipation or failure to pass regular bowel movements

Children who don’t have early symptoms may experience the following signs of Hirschsprung’s disease as they get older:

• Constipation that becomes worse with time
• Loss of appetite
• Delayed growth
• Passing small, watery stools
• Abdominal distention

What are the treatment options for Hirschsprung's disease?

When Hirschsprung's illness is first identified, our surgeons often conduct a single procedure to correct intestinal blockage. The surgery's purpose is to remove the damaged piece of the intestine and draw the healthy portion down to the anus. This is referred to as a pull-through operation. Most of the time, this procedure may be performed using minimally invasive approaches. It is occasionally possible to execute it totally through the anus, leaving no scars. Your surgeon will be able to discuss several surgical approaches with you in order to select the best option for your kid.

Food Allergies

A food allergy occurs when your child's body develops an adverse immunological response to a certain food. This is distinct from food intolerance, which has no effect on the immune system. This is true even if some of the same symptoms are present.

What causes food allergy in a child?

To keep your child healthy, his or her immune system battles viruses and other threats. Food allergies develop when your child's immune system determines that a food is a "threat" to his or her health. It is unclear why this occurs. Immunoglobulin E (or IgE) antibodies are produced by your child's immune system. When these antibodies react with food, histamines and other substances are released. These compounds can cause hives, asthma, mouth irritation, difficulty breathing, stomach discomfort, vomiting, or diarrhea. In very allergic youngsters, it doesn't take much of the food to produce a serious response.

Most food allergies are caused by these foods:

• Milk
• Eggs
• Wheat
• Soy
• Tree nuts
• Peanuts
• Fish
• Shellfish

The most prevalent causes of food allergies in children are eggs, milk, and peanuts. Although many children "grow out" of their allergies, certain food sensitivities are permanent. Consult your child's allergy healthcare practitioner about his or her food sensitivities.

What are the symptoms of food allergy in a child?

Allergic reactions might occur between minutes to an hour of consuming the dish. Symptoms may manifest differently in each child. They may include the following:

• Severe nausea or vomiting
• Diarrhea
• Stomach cramps or stomach pain
• Red, itchy rash (hives)
• Swelling of the face
• Eczema
• Itching or swelling of the lips, tongue, or mouth
• Itching or tightness in the throat
• Dizziness, with lowered blood pressure
• Asthma symptoms, such as coughing, runny or stuffy nose, wheezing, or trouble breathing
• A feeling of impending doom

In very allergic youngsters, it doesn't take much of the food to produce a serious response. In fact, a tiny bit of peanut or a short sip of milk can produce a serious allergic reaction in a youngster.

Some newborns may develop non-fatal, delayed allergies to milk, soy, or other allergens. These symptoms are frequently distinct from those of other allergies. Instead, they might include:

• Colic or fussy behavior
• Blood in your child’s stool
• Poor growth
• Severe eczema that doesn't go away.

These non-life threatening allergies might resemble other health issues and are frequently difficult to detect with allergy testing. Make an appointment for your child to visit a doctor for a diagnosis.

How is food allergy treated in a child?

Currently, there is no medication available to prevent food allergies in youngsters. The purpose of therapy is to avoid foods that trigger the symptoms. It is critical that your child does not consume these or comparable items in that food category. If you are breastfeeding your kid, consult with your child's allergist to see if you should avoid these foods as well.

If your kid is unable to consume certain foods, it may be necessary to supplement his or her diet with vitamins. Consult with your child's doctor about this. Children with food allergies who are at risk of having a severe response (anaphylaxis) should always have two epinephrine autoinjectors on hand. This reduces the severity of the symptoms of severe responses. Your child's doctor or nurse may show you how to use it.

Some children's allergies may outgrow them. Follow-up testing or dietary challenges will be discussed with you by your child's healthcare professional. Many allergies in children may be transient. After the age of three or four, your child may be able to eat the meal. Only reintroduce a meal after consulting with your child's healthcare practitioner. This is due of the possibility of a strong response.

If your kid is allergic to milk, therapy may involve switching to a soy formula. If your kid has issues with soy formula, your child's doctor may recommend an easily digestible hypoallergenic formula.

Celiac disease

Celiac disease is a digestive ailment caused by the consumption of gluten, a protein present in wheat, barley, and rye. Gluten may be found in bread, spaghetti, cookies, and cake.

Researchers do not know what causes celiac disease. According to research, celiac disease primarily affects those who have certain common genes, which are carried by around one-third of the population. Celiac disease can occur at any time after introducing wheat or other gluten-containing foods into the diet, commonly between the ages of 6 and 9 months.

The small intestine is harmed by celiac disease. The illness is especially dangerous in youngsters because it can interfere with nutritional absorption, which is essential for optimal growth and development. Children with celiac disease may develop:

• Damage to the permanent teeth’s enamel
• Delayed puberty
• Failure to thrive in infants
• Slowed growth and short height
• Weight loss

Symptoms of Celiac Disease in Children

Celiac disease symptoms in youngsters vary greatly. They might last a few hours or many days or two weeks. Symptoms might range from moderate to severe.

Symptoms can include, but are not limited to:

• Abdominal pain or bloating
• Chronic diarrhea
• Constipation
• Gas
• Pale, foul-smelling or fatty stools that float
• Weight loss
• Delayed growth

Older children and teens may have symptoms or concerning signs that are not obviously related to the intestinal tract. They can include:

• Stunted growth
• Weight loss
• Delayed puberty
• Achy pain in the bones of joints
• Chronic fatigue
• Recurrent headaches or migraines
• Itchy skin rash
• Recurring mouth sores

It's critical to test your child for celiac disease at the first indication of symptoms, or if the condition runs in your family. Parents, siblings, or offspring of celiac disease patients have a one in ten risk of getting the illness.

Diagnosing and Treating Celiac Disease in Children

Celiac disease can be difficult to diagnose since certain symptoms overlap with those of other disorders. If celiac disease is suspected, your child's physician will first take a medical and family history before performing a physical exam and perhaps ordering testing. Blood testing, genetic tests, and intestinal or skin biopsies are all possible.

The majority of youngsters react well to therapy by transitioning to a gluten-free diet. 

Functional Abdominal Pain

Functional abdominal pain (FAP) is defined by the Rome criteria as weekly abdominal pain that lasts at least two months.  The position of the discomfort distinguishes it from FD, and the absence of gastrointestinal symptoms distinguishes it from IBS. Functional abdominal pain syndrome occurs when pain interferes with activities or is accompanied by other somatic symptoms (for example, headache, sleeping difficulty, extremities pain, or dizziness) 

The frequency among Western children ranges from 0.3% to 19%, with a median of 8.4%. Women and children over the age of four through adolescence had the highest frequency.

Children with FAP, like those with IBS, appear to have an underlying visceral hypersensitivity. Children with IBS and FAP, for example, exhibit higher rectal sensitivity when compared to controls. Furthermore, these children demonstrate aberrant pain referral following rectal distension, implying altered pain receptors and/or interpretation. Visceral hyperalgesia sites can distinguish between FAP and IBS; IBS patients had more rectal hypersensitivity than FAP children, and FAP patients have more stomach hypersensitivity than IBS patients.

Caring for children with FAP may be challenging for both parents and doctors. Many parents give their children additional attention in the hopes of alleviating their children's misery.

Parents of children suffering from stomach discomfort assessed "distraction" as having a higher detrimental influence on their kid than "attention." Surprisingly, as compared to the attention group, the children in the distraction group regarded their parents as making them feel better.

The medicines used to treat IBS abdominal discomfort are likewise utilized to treat FAP sufferers. Complementary medical techniques have also been employed. When compared to medical therapy, gut-directed hypnotherapy is particularly successful in the treatment of children with persistent FAP or IBS, displaying a reduction in pain levels.

Conclusion 

Common gastrointestinal symptoms in children include functional issues such as frequent or persistent stomach discomfort, reflux symptoms, irritable bowel syndrome (IBS), and constipation. Diagnosis of a gastrointestinal ailment can be challenging and frustrating, in part because many of these conditions have similar symptoms.