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Paediatric Gastroentrology and Hepatology

Treatments & Procedures

Celiac disease can be completely cured in most cases by simply altering the diet to remove all gluten products. When gluten is removed from the diet the intestinal damage recovers and the symptoms resolve. Because gluten products are found in many processed foods, people with celiac disease need to be educated on how to carefully read food labels for potential hidden sources of gluten and avoid contamination of anything they eat with gluten products. Expert nutritionists at KIMS will work with patients and their families to educate them in this regard. Celiac disease is a lifelong condition so once a diagnosis is confirmed the gluten free diet will need to be followed for life. Failure to do so can have potentially serious health consequences over time.

Gastroparesis is a condition where the stomach contracts less often and less powerfully, causing food and liquids to stay in the stomach for a long time. Gastroparesis can be caused by viral infections, scar tissue, previous stomach surgery, some medications, neurologic problems, and endocrine problems including diabetes, adrenal problems, and thyroid disease. If an underlying disease or problem is found that is causing the gastroparesis, this should be treated if at all possible. Changing the diet can be helpful. Fats normally cause the stomach to empty more slowly, so avoiding high fat foods can be helpful. High fiber foods, such as broccoli and cabbage, stay in the stomach longer, so these should also be avoided when symptoms are severe. Eating multiple small meals a day rather than three large meals may be useful. Liquids leave the stomach faster than solids, so liquids such as low fat milkshakes should be used.

KIMS Center for Pediatric and Adolescent Inflammatory Bowel Disease (IBD Center) focuses on comprehensive care for children with Crohn's disease and ulcerative colitis using a multidisciplinary approach. We have a team of expert physicians, surgeons, psychologists, researchers, dietitians, nurse practitioners, nurses and social workers who provide diagnostic services, clinical management, patient and family education, nutritional guidance and counselling. Our goal is to improve the medical, surgical, psychological and social care of all children with inflammatory bowel disease regionally through direct patient care.

Intestinal support is the need for intravenous nutrition, tube feeding, or both because the intestine cannot absorb enough nutrients when taken by mouth. There are many problems that can result in infants, children and adolescents needing intestinal support. These can include short bowel syndrome, gastroschisis, omphalocele, Hirschsprung's disease, pseudo-obstruction, among others. Short bowel syndrome has many causes which can include necrotizing enterocolitis, atresia, volvulus, trauma, vascular infarct, meconium ileus, and congenital short bowel syndrome. Our ultimate goal is to get children to the point that they no longer require either parenteral or enteral nutrition. These problems include diarrhea, small bowel bacterial overgrowth, decreased bone density (osteopenia, osteoporosis), kidney stones, and, for those on parenteral nutrition, line infections, TPN-associated liver disease, and thromboses associated with the need for central lines. For those who develop irreversible intestinal or liver failure, we offer several world-class transplant programs.

Sacral nerve stimulation is a promising new therapeutic modality for urinary or fecal incontinence and chronic constipation in children when other treatments have been unsuccessful. Sacral nerve stimulation (sometimes called sacral neuromodulation) is used as a last resort, after the patient has tried other treatments such as medications and behavioral therapy. It involves the implantation of the device and ongoing medical management address communication problems between the brain and the nerves that control bowel and bladder function. If the nerves are not communicating properly, the muscles may not function properly which leads to control problems (incontinence). The implanted device delivers mild electrical pulses to the pelvic nerves. The pelvic nerves, in turn, begin to tell the muscles when to contract, ultimately helping control the ability to urinate or have a bowel movement.


RUMINATION SYNDROME

Rumination Syndrome is a condition that occurs when people constantly regurgitate and either vomit or re-swallow their food or drink soon after eating. Although the syndrome was first described many years ago as occurring in young children with developmental disabilities, it is now recognized that the syndrome often occurs in children and adolescents with intact cognitive skills. While some patients with rumination syndrome can be treated in the outpatient setting closer to their homes, other patients benefit from an admission to the hospital. An inpatient admission is essential for patients who are reliant on tube feedings or parenteral nutrition, as their nutrition and hydration need to be closely monitored.


POLYPOSIS SERVICES

Polyposis is an inherited colorectal cancer syndrome that can be passed from one generation to the next by a specific error or mutation in the genetic code of the APC gene. Virtually everyone that carries a mutation of the APC gene will eventually develop cancer in the lower part of the digestive system, including the large intestine (colon) and rectum. This disease can become active in childhood with the development of adenomatous polyps causing bleeding with bowel movements, diarrhea, or abdominal pain usually in the mid teenage years however, exceptions are the rule. The diagnosis and management of these children and their families is a multidisciplinary process that includes primary care physicians, geneticists, genetic counselors, adult and pediatric gastroenterologists, social workers, and surgeons. With a focus on identifying and controlling the disease process, KIMS is helping each of these children with a polyposis disorder and their families by developing a comprehensive, multidisciplinary management plan that seeks to reduce the fear, uncertainty, and needless suffering that can accompany these syndromes.


MOTILITY SERVICES

Suffering from motility problems, which can result in chronic abdominal pain, vomiting, diarrhea, constipation, abdominal distension and difficulty swallowing, can be emotionally difficult for both parents and children. It is often difficult to understand the diagnosis and treatment of motility disorders. Children who suffer from motility problems frequently undergo countless and often invasive tests and procedures to determine a proper diagnosis and treatment. Many times, these tests provide no explanation for the symptoms. At KIMS, we use advanced diagnostic techniques that are only offered a few places in the world and treat patients using a comprehensive biopsychosocial approach.

Our Pediatric Endoscopy suite and Infusion Center features a new generation of high-definition endoscopes and monitors that permit direct visualization of the various digestive pathways. This superior visualization results in better detection of abnormalities. Our team actively collaborates with other pediatric subspecialty providers in the treatment of pediatric obesity and its associated metabolic complications.

We offer specialized evaluations for children with conditions such as cyclic vomiting syndrome, myelomeningocele (spinal problem), feeding problems and children with GI problems associated with airway and lung disease. Our pediatric psychology and pain therapy team help children with chronic disease learn to cope with pain and other symptoms through biofeedback and other techniques.

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