Clinical & Epidemiological study: Pediatric Gastroenterology & Hepato-biliary sciences

Greetings from Pedgihep group!

In upcoming vol42, pedgihep, ejournal:

VOL42. First, Clinical & epidemiological profile of Pediatric Gastroenterology & Hepato-Biliary sciences in Central India

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Salient features:
Retrospective study. 2 years.
Center: Dept of Pediatric Gastroenterology & Hepatology, Care Hospital, Nagpur.
Included: all diagnosed and completely worked up cases.
Excluded: partly worked cases / lost to follow up /documents papers not available.

We are committed to nontraditional, evidence based, point wise handling of mono-thematic specific issues in Pediatric Gastroenterology & Hepatology practice.We appreciate your time with us.

thanking you,
Dr.Yogesh Waikar

Clinical section PEDGIHEP for health care professionals

log on: http://www.pedgihep.jigsy.com E- JOURNALS/ book chapters/ original articles/ abstracts 

Book section editor :Atlas of Pediatric Infectious diseases, Jaypee publisher, 2013,section 4,Gastrointestinal infections.pg. 49-56

Article in press: review of probiotics in children.http://www.pediatricinfectiousdisease.net/article/S2212-8328(13)00039-8/abstract

Book chapter: Recent advances in Pediatrics vol23, Pediatric Gastroenterology, Hepatology& Nutrition, 2013 publisher: jaypee. Chapter 15.Portal Hypertension. Published.

Book chapter: Recent advances in Pediatrics vol23, Pediatric Gastroenterology, Hepatology& Nutrition, 2013 publisher: jaypee. chapter 27.Probiotics . published.

IAP Pediatric Infectious disease color atlas; section editor Pediatric Gastroenterology & Hepatology. Published. Jaypee publisher.

Vol 41, Basics of childhood difficult diarrhea.

Vol 40 ,Pancreatic enzyme replacement therapy. Free access: clinical section.

Vol 39, Haemo-peritoneum  do’s and don’ts.

VOL 38, Surgical intervention in pediatric GERD : when  and why ?

Vol37, Nacetylcysteine in non PCM  Acute Liver Failure : new criteria(clinical section):FREE ACCESS

VOL 36, Difficult Celiacs in central India.(clinical section):FREE ACCESS

Vol 35 , 2012. evidence based upper GI issues .

Vol 34, Meta-review Post Kasai Porto-enterostomy.

Vol 33, Small Bowel Enteroscopy in children

VOL32, PERI-OPERATIVE MANAGEMENT OF PATIENTS WITH LIVER DISEASES on line.

Vol 31,H pylori management guidelines .

Vol30,  Review of Non-variceal Upper GI Hemorrhage in children.

Vol 29, Liver regenerative Medicine series:  Pediatric Hepatocyte Transplant.

Vol 28,Familial adenomatosis polyposis coli.

Vol 27, Ammonia and Hepatic Encephalopathy.

Vol 26 , Recent advances in Pediatric gastroenterology & hepatology.

Vol  25; Endoscope disinfection and reprocessing.

Vol 24, Outcome in Liver Failure.

Vol 23, ABC of Neonatal jaundice guidelines.

Vol 22, Pharmacological aspects of treatment of hpylori infection in children part 2.

Vol 21,Pharmacological aspects of treatment of hpylori infection in children part 1.

Vol 20, Missed issues in pediatric upper GI.

Vol 19, Practical approach to Hepatic encephalopathy in children.

Vol 18. Management of acute liver failure in children.

Vol 17, Recent advances in Pediatric Nutrition.

Vol 16 , Pharmacobiotics.

Vol 15 , Food allergies: diagnosis & management.

Vol 14 , Recent advances in pediatric GERD.

Vol 13. Non- variceal upper gi bleed in children.

Vol 12 Position statement on GI endoscopy.

Vol 11, Hiatus hernia : management in children.

Vol 10, Gut protective NSAID’S .

Vol 9 , Abnormal LFT’S : stepwise approach.

Vol 8, Pancreas & Biliary system : GREY ZONES .

Vol 7 Supplement : Gluten in drugs.

Vol 6 , Preclinics in gastrointestinal embryology.

Vol 5 , Guidelines on Wilson disease management .

Vol 4, Celiac disease .

Vol 3, Nutritional issues in Pediatric intestinal failure.

Vol 2, Chronic liver disease and nutrition.

Vol 1, GERD.

Is functional pain more common in children with Celiac disease?

good one…

gutsandgrowth

A recent study adds information to the title question but does not resolve it (J Pediatr 2013; 162: 505-09).

The authors note that they expected to find a higher prevalence of abdominal pain and abdominal pain/functional gastrointestinal disorders among children with diagnosis of celiac disease.  They note that functional disorders have been more common after acute gastroenteritis and cow’s milk hypersensitivity of infancy presumably due to preceding inflammation.  Persistent low-grade intestinal inflammation and immune activation have been proposed as precipitating susceptibility to functional abdominal pain.

In this small retrospective study, a statistically significant difference in functional GI disorders was not observed.  Enrolled families were contacted by telephone at least 6 months after the diagnosis of Celiac disease.  They completed a telephone questionnaire and a separate Rome III questionnaire.

Celiac cases (n=49):  abdominal pain (24.5%), functional abdominal pain (4.8%), IBS (6.1%), dyspepsia (4.8%), abdominal migraine (4.8%), nonspecific abdominal pain…

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Teens Susceptible to Hepatitis B Infection Despite Vaccination as Infants

need a thought on….

Pancreas problems in children.

A healthy pancreas produces digestive enzymes and insulin. The digestive enzymes flow into the small intestine to help break down food. Insulin is released into the blood to control the level of sugar (glucose) in the blood.

Pancreatitis is a condition that occurs when the pancreas, an organ behind the stomach, becomes swollen and painful. Acute pancreatitis occurs as one sudden episode. It is one of the commonly missed causes of abdominal pain in children.After acute pancreatitis the pancreas usually returns to its normal condition. Chronic pancreatitis means ongoing or repeated bouts of pancreatitis in which there is permanent damage to the pancreas.

Trauma / abdominal injury is one of the most common causes of damage to pancreas. Other causes are gallstones, side effects from some medicines, unavoidable bruising during surgery, damage from disease in nearby organs, such as stomach. Gallstones can block the flow of digestive enzymes into the intestines. When the enzymes stay in the pancreas, they irritate it. Congenital, hereditary and autoimmune causes of Pancreatitis are also known in children. Body biochemical abnormalities like calcium, lipids can also cause pancreatitis.The main symptom is severe pain in the upper abdomen .child stoops forward , associated with vomiting and irritability. occasionally jaundice or fever may follow. Abdominal distension may be seen.

Pediatric gastroenterologist may advice some blood test/x-ray / sonography. If extent of damage is not visible and disease is suspected CT scan may be suggested. Congenital abnormalities of pancreas are better depicted on MRI.

Depending on the clinical condition child may be admitted in PICU or may be managed on OPD basis.

Main function of pancreas is to digest. Food stimulates Pancreas increasing pain. For 3 to 4 days child may be kept nil by mouth. During the period I v fluids may be given. Once the pain reduces special diet can be started in small amount initially. Medicine for pain may continue. If gallstones caused the pancreatitis and they have not been removed, surgery to remove them may help prevent further attacks.

Most children recover completely, especially if the disease is diagnosed early enough. Early consultation with pediatric gastroenterologist is advisable. Pancreatitis can come back and become an ongoing problem, causing frequent, severe pain. It can permanently damage the pancreas.

Follow the instructions your Pediatric gastroenterologist gives you. Don’t take any other medicines, including nonprescription drugs, without asking your healthcare provider. Follow the diet prescribed.

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Childhood Cirrhosis: Reversible to Irreversible Liver Disease

Cirrhosis is the term used to describe a diseased liver. Cirrhosis cannot be cured. But complications of cirrhosis can be reduced by taking proper dietary steps, medicines and procedures required. In simpler terms scarring of liver is called as cirrhosis. Scarring occurs due to persistent insults/infection or damage to Liver. Many children with advanced cirrhosis have jaundice. children with cirrhosis are at increased risk for developing liver cancer. In children, metabolic liver disease, Wilson disease, neonatal cholestasis, Hepatitis B, Hepatitis C can lead to Cirrhosis.

Scarring makes it difficult for blood to flow through the liver. As a result, veins in other areas outside of the liver become abnormally expanded. Abnormally expanded blood vessels are referred to as varices. One place where varices are commonly found is in the esophagus, the swallowing tube connecting the mouth with the stomach .when the pressure in the varices reaches a certain level, the varices can burst, which can cause massive bleeding/vomiting. Patients with cirrhosis are at risk of easy bruising and bleeding. Once bleeding starts it can be severe. Liver performs important function to reduce bleeding by producing coagulation proteins. In cirrhosis production of these reduces hence the bleeding tendencies.

Body fluids accumulate as a result of liver scarring and a decreased ability to manufacture blood proteins. Fluid is typically seen in the legs and abdomen (ascites) and sometimes in the lung Ascites causes the abdomen to enlarge as fluid accumulates, which can cause shortness of breath and a feeling of fullness. The fluid provides an environment where bacteria can grow, increasing the risk of infection.

Hepatic encephalopathy is a condition that develops when the liver is unable to break down toxins normally found in the bloodstream, such as ammonia. In this condition, confusion or even coma are caused by toxins that build up in the blood. In the early stages, there may be mild symptoms, such as difficulty sleeping or sleeping too much. Advanced hepatic encephalopathy can cause confusion, delirium, and even coma. Hepatic encephalopathy can develop suddenly and may become a medical emergency.

Children with cirrhosis should see Pediatric gastroenterologist regularly for monitoring and treatment of cirrhosis complications. Although cirrhosis cannot be cured, several treatments are available to minimize cirrhosis-related complications. Endoscopic variceal ligation may be required every 2 months initially to control bleeding. Band ligation of enlarged vessels helps in reducing the chances of bloody vomiting and is a safe procedure. Ascites (fluid in abdomen) may require tapping for diagnostic analysis. In case of severe breathlessness with distended abdomen large amount of fluid may be removed and is supplemented with albumin. Hepatic encephalopathy earlier diagnosed can be reversed with appropriate treatment.

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Vomiting & Diarrhea in Children

Vomiting and diarrhea are mainly due to problems of stomach and intestines. Vomiting and diarrhea in children are often caused by a virus infection. Vomiting usually lasts a few hours. And diarrhea may last a couple of days in most situations. Other cause of vomiting includes head injury, abdominal injury, infections in other part of body, side-effects of medicines. Proper diagnosis leads to proper treatment. Diarrhea and vomiting is one of the major reasons for childhood hospitalization.In viral infections of intestines antibiotics are not required. We should keep a watch on urine output. Lower the urine volume more is the dehydration. Unnecessary, stopping breast milk in infants, milk in children should be avoided. ORS should be given add libb. Fruit juices should be avoided. IV fluids are needed for severe dehydration. If your child’s diagnosis is not clear, tests may be needed.Give your child a normal diet unless told otherwise. Avoid high fat foods. Do not force your child to eat. It is common for a child to have little appetite when vomiting. If vomiting right after nursing, nurse for shorter periods of time more often. If vomiting is better after 3 to 4 hours, return to normal feeding schedule. If your child has started solid foods, do not introduce new solids at this time. Replace any fluid losses from diarrhea and vomiting with ORS or clear fluids. Prevent the spread of infection by washing hands. Prevent diaper rash by frequent diaper changes, cleaning the diaper area with warm water on a soft cloth.Contact Pediatric Gastroenterologist /pediatrician immediately if:Confusion or decreased alertness, Sunken eyes, Pale skin, Dry mouth, No tears when crying, Rapid breathing or pulse, Weakness or limpness, green or yellow vomit, abdominal pain, Vomiting red blood, Severe headache, bloody Diarrhea, fever uncontrolled by ,medicines.

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Recurrent abdominal pain in children

Recurrent abdominal pain (RAP) syndrome is a common cause of repeated belly ( abdominal) pain in otherwise healthy children. It is a common cause for missing school and other activities. Common symptoms of RAP include:Repeated episodes of belly pain – usually around the belly button,Pain that lasts 1 to 3 hours,The child often lies down with the belly pain.,After the pain, the child acts normally.
Pediatric Gastroenterologist may suggest writing down: When the pain comes. How long it lasts.
What helps? Where the pain is located? . Aggravating or relieving factors. Most of time, cause is trivial and pain can be controlled by medicines after appropriate diagnosis.Your pediatric gastroenterologist may suggest trial of medicines or if necessary blood investigations /sonography.Pediatric endoscopy to find the exact cause of abdominal pain is a safe procedure in experienced hands.Consult Pediatric Gastroenterologist immediately if:The pain is worse or more frequent, The pain is located in one place (other than the belly button)., Pain wakes your child up at night.,Pain comes with eating., Heartburn., Unexplained fever., Weight loss.,Diarrhea or constipation., Feeling sick to one’s stomach ( nausea) or repeated vomiting., Excessive belching.,Your child looks pale, tired or disoriented during or after the pain., Urinary pain or frequent urination. Blood in stools (red, dark red, or black stools).Empirical Treatment may subside pain for a while but recurrences are known.If no cause identified, pain is likely due to sensitized developing GUT and due to psychological factors.Appropriate treatment is possible with early consultation.

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