Pediatric gastroenterology

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Pediatric gastroenterology developed as a sub-specialty of pediatrics and gastroenterology. It is concerned with treating the gastrointestinal tract, liver and pancreas of children from infancy until age eighteen. The principal diseases it is concerned with are acute diarrhea, persistent vomiting, gastritis, and problems with the development of the gastric tract.

Contents

History

Pediatric gastroenterology has grown greatly in North America and Europe. It began with the speciality of pediatrics, which was developed along with children’s hospitals in the 19th century. The concept of specialists concentrating on organ specific specialties started around the same time. A person who contributed to the development of the specialty was Dr. Samuel Gee in London with his focus on serious clinical conditions in children such as celiac disease and cyclic vomiting syndrome. The first national gastrointestinal society was created in Germany in 1920 by Ismar Isidor Boas. He was also the first physician devoted completely to only gastroenterology. Later the American Gastroenterological Association was founded in 1897 by Dr. D. Stewart. The combination to make a pediatric gastroenterological a specialty emerged in the 1960s, almost a century after the specialties of pediatrics and gastroenterology started out individually. All pediatric specialties started out with the concept that children with special needs were not receiving the adequate medical attention that they needed. [1]

Margot Shiner, who in 1956 invented a biopsy tube that could be used to diagnose intestinal disease in children, particularly celiac disease, has been credited with initiating the emergence of pediatric gastroenterology as a distinct clinical specialty. [2] [3] [4]

Centers of pediatric gastroenterology

Centers for gastrointestinal disorders in children began being established in the 1960s in Great Britain, Australia, and continental Europe. The first centers for pediatric gastroenterology were established by Dolf Weijers and the biochemist Van de Kamer. Pediatricians and biochemists were crucial to the development of such specialty since they created the ability to calculate the fat in the feces of celiac patients with or without gluten. A clinical and research program in pediatric gastroenterology and a gastroenterological research were established in the 1960s at the Royal Children’s Hospital in Melbourne by Charlotte Anderson. Later on an important center focused on nutrition and gut pathophysiology was established by Bertil Linquist in Lund, Sweden. This was the first place in which glucose-galactose malabsorption was reported. Pediatric gastroenterology centers in London contributed greatly to this field and hepatology by helping and recognizing multiple doctors with their investigations. An example is Tom Macdonald, who concentrated his immunological research on gastroenterological diseases in children and the use of a fetal intestinal organ culture model. Important pediatric gastroenterology centers were also established in Helsinki and Tampere, Finland. These centers, led by Jamro Visakorpi, primarily focused on celiac disease, gastroenteritis¸ and food allergies. Other important centers were established in Switzerland, under the leadership of Andrea Prader making Zürich one of the first main centers for pediatric gastroenterology. In that same center, David Shmerling started studying gluten elimination and celiac disease. Salvatore Auricchio along with Giorgio Semenza began comprehending and identifying sugar absorption disorders in children. Ettore Rossi in Bern founded centers in which Beat Hadorn and Michael Kentze, who later went on to establish German centers in Munich and Bonn, which made great contributions in the research of absorption pathophysiology. After working in Zurich, Salvatore Auricchio went on to establish an important center in Naples which focused research on celiac disease, the physiology of absorption, and oral re hydration therapy. In a center located in Brussels, led by E. Eggermont and Helmuth Loeb, Samy Cadranel started developing the concept of endoscopy in children. [1]

Centers of pediatric gastroenterology in North America

North America has also been a center for the development of pediatric gastroenterology. A pediatric gastroenterology program focusing on researching inflammatory bowel disease, infectious diarrhea, and motility disorders associated with gastrointestinal complications such as constipation and gastro esophageal reflux was established by Murray Davidson at the Albert Einstein Medical School and the Bronx-Lebanon Hospital Center in New York. Harry Shwachman created the center of excellence for pediatric gastroenterology in Boston in the early 1960s. This center, under the leadership of Richard Grand and Allan Walker, went on to become a major training program for pediatric gastroenterologists. In order to commemorate Dr. Shwaschman and his impact to the field, a Scwaschman Award is given annually since 1984 by the North American Society for Pediatric Gastroenterology and Nutrition to a person with important contributions to the field. In Canada, gastroenterology and hepatology surged independently from nutrition at the Hospital for Sick Children (HSC) in Toronto. Peter Durie combined the nutrition and gastroenterology research at the HSC in 1985. [1]

Many more centers have been developed in multiple places including Sydney, Adelaide, Brisbane, Jerusalem, São Paulo, Santiago, Taipei, and Tokyo. [1]

Education

The specialty of pediatric gastroenterology requires four years of undergraduate courses at a college or university in order to obtain a BS, BA, or other bachelor's degree. During these four years a student studying pediatric gastroenterology can also take a pre-med course. Afterwards, the student needs four years of medical school in order to obtain an MD or DO degree and become a general doctor. Afterwards the student needs to take a specialty in pediatrics consisting in three more years of education called residency. Afterwards pediatrics sub-specialize in a more specific area such as pediatric gastroenterology. The time to sub-specialize is called post-residency training also known as a fellowship. It can take from one to three or more years consisting in a total of fourteen years or more. In the United States, the committees to certify pediatric gastroenterologist were created in the 1980s. This gave rise to sub-specialty boards in pediatric gastroenterology in 1990 under the leadership of American board of Pediatrics and its Pediatric Gastroenterology and Nutrition subspecialty sub-board, led by Bill Kish. A formal training program was created later in 1997 by the sub-specialty advisory committee for pediatric gastroenterology of the royal college of pediatrics and child health in Great Britain. [1]

Nutrition

The correct function of the gastric tract and the internal health is related to the nutrition that the child or its mother receives. From the prenatal period, correct nutrition can affect the developing of the system, short bowel syndrome (the most common one), necrotizing enterocolitis, gastroschisis or omphalocele to the postnatal period with diseases such as diarrhea. [5] [6]

One of the principal problems of a newborn is an iron deficiency, which will generate anemia. This is caused when the only food that the baby receives is maternal milk which does not fulfill the baby’s nutrition. There is no treatment for this in this period because iron will reach normal levels with the weaning process. The weaning process consists in transitioning from feeding the baby low density food such as maternal milk to start feeding it more complex foods such as meat, fish, or chicken. (uniped) If the weaning process is not carried out correctly or if the child rejects the transition of food the iron deficiency will generate an anemia or even create allergies to certain food. In such cases gastric pediatricians, and not regular pediatricians, should be consulted to treat the anemia because they will now how to recover the correct iron levels without causing any secondary effects in the digestive system. [7]

The most common nutrition problems during the childhood are being overweight or underweight, both caused by an imbalance in the number of calories consumed versus the number burned. Both in children should be treated by a gastric pediatrician and a pediatric nutritionist at the same time to help the child recover his normal weight without secondary effects (hypertension, gastritis, etc.). The nutritionist will regulate the eating habits of the child, however, the pediatric gastroenterologist will be the one checking how the change in food habits affects the correct functionality of the digestive system. [5]

Diseases

A pediatrician can provide treatment to many gastric diseases, but chronic diseases, related with the nutrition of the children, the pancreas or the liver needs to be treated by a specialist. The following are two of the most common ones. Acute diarrhea is one of the most common. Globally, each of the 140 million children born annually experience an average of 7-30 episodes of diarrhea in the first 5 years of life. Some of the causes are infections, lower levels of zinc or problems with some gastric cells. [5]

Infant regurgitation is caused by a central nervous system reflex involving both autonomic and skeletal muscles in which gastric contents are forcefully expelled through the mouth because of coordinated movements of the small bowel, stomach, esophagus, and diaphragm. Diagnosis requires that the child be between 1 and 12, the regurgitation must be two or more times per day for three or more weeks, and there is a strong involuntary effort to vomit, hematemesis, aspiration, apnea, failure to thrive, or abnormal posturing. This is transient problem, possibly cause to the immaturity of gastrointestinal motility. [6]

Related Research Articles

<span class="mw-page-title-main">Gastroenterology</span> Branch of medicine focused on the digestive system and its disorders

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver.

<span class="mw-page-title-main">Diarrhea</span> Loose or liquid bowel movements

Diarrhea, also spelled diarrhoea or diarrhœa in British English, is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

<span class="mw-page-title-main">Constipation</span> Bowel dysfunction

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.

<span class="mw-page-title-main">Gluten-free diet</span> Diet excluding proteins found in wheat, barley, and rye

A gluten-free diet (GFD) is a nutritional plan that strictly excludes gluten, which is a mixture of prolamin proteins found in wheat, as well as barley, rye, and oats. The inclusion of oats in a gluten-free diet remains controversial, and may depend on the oat cultivar and the frequent cross-contamination with other gluten-containing cereals.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

<span class="mw-page-title-main">Intestinal pseudo-obstruction</span> Medical condition

Intestinal pseudo-obstruction (IPO) is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through. It is characterized by the signs and symptoms of intestinal obstruction without any lesion in the intestinal lumen. Clinical features mimic those seen with mechanical intestinal obstructions and can include abdominal pain, nausea, abdominal distension, vomiting, dysphagia and constipation depending upon the part of the gastrointestinal tract involved.

Chronic diarrheaof infancy, also called toddler's diarrhea, is a common condition typically affecting up to 1.7 billion children between ages 6–30 months worldwide every year, usually resolving by age 4. According to the World Health Organization (WHO), diarrheal disease is the second greatest cause of death in children 5 years and younger. Diarrheal disease takes the lives of 525,000 or more children per year. Diarrhea is characterized as the condition of passing of three or more loose or watery bowel movements within a day sometimes with undigested food visible. Diarrhea is separated into three clinical categories; acute diarrhea may last multiple hours or days, acute bloody diarrhea, also known as dysentery, and finally, chronic or persistent diarrhea which lasts 2–4 weeks or more. There is normal growth with no evidence of malnutrition in the child experiencing persistent diarrhea. In chronic diarrhea there is no evidence of blood in the stool and there is no sign of infection. The condition may be related to irritable bowel syndrome. There are various tests that can be performed to rule out other causes of diarrhea that don't fall under the chronic criteria, including blood test, colonoscopy, and even genetic testing. Most acute or severe cases of diarrhea have treatment guidelines revolving around prescription or non prescription medications based on the cause, but the treatment protocols for chronic diarrhea focus on replenishing the body with lost fluids and electrolytes, because there typically isn't a treatable cause.

FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are short-chain carbohydrates that are poorly absorbed in the small intestine and ferment in the colon. They include short-chain oligosaccharide polymers of fructose (fructans) and galactooligosaccharides, disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol, and maltitol. Most FODMAPs are naturally present in food and the human diet, but the polyols may be added artificially in commercially prepared foods and beverages.

Karoly Horvath is a Hungarian-American pediatrician and gastroenterologist who was formerly the director of the Pediatric Gastroenterology and Nutrition Laboratory at the University of Maryland School of Medicine. He is best known for proposing a link between secretin, gastrointestinal disorders and autism and for, as a result, proposing that secretin might be an effective treatment for autism.

<span class="mw-page-title-main">Alessio Fasano</span> Medical doctor and researcher on celiac disease

Alessio Fasano is an Italian-born medical doctor, pediatric gastroenterologist and researcher. He currently holds many roles, including professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard T.H. Chan School of Public Health, both in Boston. He serves as director of the Center for Celiac Research and Treatment at MassGeneral Hospital for Children (MGHfC) and co-director of the Harvard Medical School Celiac Research Program. In addition, he is director of the Mucosal Immunology and Biology Research Center at MGHfC, where he oversees a research program with approximately 50 scientists and staff researching a variety of acute and chronic inflammatory diseases, including cystic fibrosis, celiac disease, enteric infections and necrotizing enterocolitis. A common theme of these programs is the study of the emerging role of the gut microbiome in health and disease. Fasano is also the scientific director of the European Biomedical Research Institute of Salerno (EBRIS) in Italy. Along with these leadership positions, he is a practicing outpatient clinician in pediatric gastroenterology and nutrition and the division chief.

The gluten challenge test is a medical test in which gluten-containing foods are consumed and (re-)occurrence of symptoms is observed afterwards to determine whether and how much a person reacts to these foods. The test may be performed in people with suspected gluten-related disorders in very specific occasions and under medical supervision, for example in people who had started a gluten-free diet without performing duodenal biopsy.

Serum-derived bovine immunoglobulin/protein isolate (SBI) is a medical food product derived from bovine serum obtained from adult cows in the United States. It is sold under the name EnteraGam.

<span class="mw-page-title-main">Carlo Catassi</span> Italian gastroenterologist, epidemiologist, and researcher

Carlo Catassi is an Italian gastroenterologist, epidemiologist, and researcher. He is known for international studies on the epidemiology of celiac disease. Currently, he is Head of the Department of Pediatrics at the Università Politecnica delle Marche, Ancona, Italy, and Visiting Scientist at Massachusetts General Hospital in Boston, Massachusetts, United States. From 2013 to 2016, he served as President of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). His research had included contributions to understanding the clinical spectrum of celiac disease and other gluten-related disorders.

Ibrahim Mohamed Fayad was an Egyptian senior pediatrician and a Professor of Pediatrics at Kasr Al Aini School of Medicine, Cairo University.

Margot Shiner was a German-British gastroenterologist and medical researcher who worked in London and Israel. As a result of her development of a new technique to biopsy the small intestine in children, she has been credited with launching the subspecialty of paediatric gastroenterology.

Constipation in children refers to the medical condition of constipation in children. It is a functional gastrointestinal disorder.

A low-FODMAP diet is a person's global restriction of consumption of all fermentable carbohydrates (FODMAPs), recommended only for a short time. A low-FODMAP diet is recommended for managing patients with irritable bowel syndrome (IBS) and can reduce digestive symptoms of IBS including bloating and flatulence.

<span class="mw-page-title-main">Maria Oliva-Hemker</span> Cuban-American paediatrician

Maria M. Oliva-Hemker is a Cuban-American pediatrician. She is the Stermer Family Professor of Pediatric Inflammatory Bowel Disease (IBD), Director of the Division of Pediatric Gastroenterology, Hepatology and Nutrition and Vice Dean for Faculty at the Johns Hopkins University School of Medicine.

<span class="mw-page-title-main">Aleixo Muise</span> Canadian scientist and physician

Aleixo M. Muise is a Canadian scientist, pediatrician and gastroenterologist known for contributions to the understanding of very early onset inflammatory bowel disease. He is a professor of pediatrics at the University of Toronto, a Tier 1 Canada Research Chair in pediatric inflammatory bowel disease, and a pediatric gastroenterologist at the Hospital for Sick Children.

Izabel Planeta-Malecka was a Polish pediatrician, gastroenterologist and long-time researcher and lecturer at the Military Medical Academy. She was also a deputy and a member of the Polish Women's League. She won the Cross of Merit (Poland) and was a member of the World Peace Council from 1983.

References

  1. 1 2 3 4 5 Walker, Smith (2003). "The Development of Pediatric Gastroenterology: A Historical Overview". Pediatrics. 53 (4): 706–15. doi: 10.1203/01.PDR.0000057207.94133.82 . PMID   12612197.
  2. ↑ Kleinman, Ronald E. (1998). Atlas of Pediatric Gastrointestinal Disease. People's Medical Publishing House. p. 5. ISBN   978-1-55009-038-3.
  3. ↑ Branski, David (1998). "Obituary Margot Shiner 1923-1998". Journal of Pediatric Gastroenterology and Nutrition. 27 (4): 397. doi: 10.1097/00005176-199810000-00005 .
  4. ↑ "Margot Shiner". Munk's Roll, Volume XI. Royal College of Physicians. p. 519. Retrieved 13 May 2017.
  5. 1 2 3 "Gastroenterologia pediatrica". 2013. Retrieved 19 April 2013.
  6. 1 2 Weber, Rasquin (1999). "Childhood functional gastrointestinal disorder" . Retrieved 19 April 2013.
  7. ↑ "ablactacion http://www.unidaddepediatria.com.mx/pdf/Ablactacion.pdf=".{{cite web}}: External link in |title= (help); Missing or empty |url= (help)[ dead link ]
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