CONTACT WITH DR.GULCAN ~ Pediatric gastroenterolgy

Assoc. Prof. M.D. Enver Mahir Gülcan Pediatrician, Pediatric gastroentrologist

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Acıbadem Maslak Hospital
Acıbadem Kadıköy Dr.Şinasi Can Hospital

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enver.gulcan@acibadem.com

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0090 544 46 64

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PEDIATRIC GASTROENTEROLOGY FREQUENTLY ASKED QUESTIONS

What is Pediatric Gastroenterology? While many GI needs are easily treated by a child’s pediatrician or primary care provider, some conditions and illnesses require the specialized care of a pediatric gastroenterologist. This sub-specialty of pediatrics has a strong emphasis on gastroenterology with special attention to diagnosis and treatment of diseases and symptoms affecting the esophagus, stomach, small intestine, colon, liver and pancreas in infants, children and young adults up to 18 years of age. Pediatric gastroenterology has been a medical specialty in the U.S. since the 1960s, despite pediatric medicine and gastroenterology each independently becoming medical specialties nearly 100 years earlier. This was in response to a need for more specialized care in children with gastrointestinal health issues, as their needs often differed from those of adults. Today’s pediatric gastroenterologists are trained and held to rigorous standards, with less than a quarter of one percent of all physicians in the U.S. practicing in this specialty.

Children are often referred to a pediatric GI doctor for chronic or acute diarrhea, constipation, vomiting, reflux, jaundice, feeding difficulties, blood in the stool or abdominal pain. These symptoms may be related to a number of diseases and conditions, such as celiac disease, inflammatory bowel disease, liver disease, food allergies/intolerances and irritable bowel disease.

Often, a child’s primary physician or pediatrician will refer patients to a pediatric GI doctor when digestive health problems begin to interfere with a child’s life on a regular basis and growth or development. Kids who frequently miss school or experiencing ongoing or severe symptoms may need to be evaluated by a pediatric gastroenterologist.

At Pediatric Gastroenterology, we combine our strong clinical background, years of experience with radiological and diagnostic tools to identify causes of each child’s symptoms and develop a personalized treatment plan. Our commitment is to enable our patients to thrive and achieve their goals despite their underlying gastrointestinal problems. For more information about Pediatric Gastroenterology and whether it could help your child, contact our office to speak with a team member.

Endoscopic procedures are invasive procedures that allow doctors to look inside a child’s gastrointestinal system. Although most procedures require sedation, they are typically outpatient and do not require an overnight stay in the hospital. Colonoscopy (lower endoscopy). Colonoscopy is a procedure that allows the doctor to view the entire length of the large intestine (colon), and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered. Learn more about colonoscopy. Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, a long, flexible, lighted tube. The scope is guided through the patient’s mouth and throat, then through the esophagus, stomach, and duodenum (the first part of the small intestine). The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected that will allow the internal organs to appear on an X-ray. Esophagogastroduodenoscopy (EGD or upper endoscopy). An EGD a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum with an endoscope, which is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through the scope for the removal of a sample of tissue for biopsy (if necessary). Learn more about endoscopy. Sigmoidoscopy. A sigmoidoscopy is a diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

To perform the procedure, the doctor uses a long, flexible, lighted tube called an endoscope. The endoscope is guided through the patient’s mouth and throat, then through the esophagus, stomach and duodenum (first part of the small intestine). The physician can examine the inside of these organs and detect abnormalities.Diagram showing an endoscope's path through the body during an upper endoscopy, from the mouth to the stomachIn addition to performing visual examination of the UGI tract with the endoscope, the doctor can insert instruments through the endoscope to get tissue samples for a biopsy, remove foreign objects, instill air or fluid, stop bleeding or perform therapeutic procedures, such as endoscopic surgery, laser therapy or dilatation (opening up). A video camera in the endoscope provides images onto a TV-like monitor.

A colonoscope — a long, flexible tube with a light and tiny camera on one end — is inserted into your child’s rectum. This lets the doctor see the large intestine (also called the colon) and the very last portion of the small intestine, called the terminal ileum. Small tissue samples (called biopsies) are collected. A pathology laboratory will use these samples to help diagnose your child's condition. A colonoscopy is similar to a flexible sigmoidoscopy, but differs in that a colonoscopy lets the doctor examine the inside of the entire colon and rectum, not just a portion. A colonoscopy lasts longer than a flexible sigmoidoscopy (about 30 minutes vs. 5-10 minutes) but may be the best diagnostic tool for your child. Your child’s doctor will tell you which test is preferred for your child’s condition.

Gastritis is an inflammation of the stomach lining. What are the causes of gastritis? Gastritis may be caused by the following: Eating spicy foods Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) Infection with bacteria, such as Helicobacter pylori (H. pylori) Major surgery Traumatic injury or burns Severe infection Extreme physiological stress Certain diseases, such as megaloblastic (pernicious) anemia and autoimmune disorders. Adolescents and young adults may be at a higher risk for gastritis because of: Drinking alcohol Smoking. What are the symptoms of gastritis? The following are the most common symptoms of gastritis. However, each individual may experience symptoms differently. Symptoms may include: Stomach upset or pain Belching or hiccups Abdominal bleeding Nausea Vomiting Feeling of fullness or burning in the stomach Loss of appetite Blood in vomit or stool (a sign that the stomach lining may be bleeding). The symptoms of gastritis may resemble other medical conditions or problems. Always consult a pediatric gastroenterologist for proper evaluation. How is gastritis diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for gastritis may include the following: Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A procedure that allows the doctor to examine the inside of the esophagus, stomach and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach and duodenum. The endoscope allows the doctor to view this area of the body, as well as removal of a sample of tissue for biopsy (if necessary). Learn more about endoscopy. Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs. Blood tests. Tests that can help detect anemia, a condition in which there are not enough red blood cells present. Anemia can be an indicator of blood loss, which can be linked to gastritis. Learn more about blood tests at CHOC. Stool studies. These studies can be used to check for the presence of H. Pylori or other infections. A small sample of stool is collected and sent to a laboratory by your child’s doctor’s office. Learn more about stool studies. What is the treatment for gastritis? Specific treatment for gastritis is determined by your child’s doctor based on: The child’s age, overall health and medical history Extent of the condition Other medical conditions The child’s tolerance of specific medicines, procedures or therapies Expectations for the course of the condition The family’s opinion or preference. Patients are sometimes advised to avoid foods, beverages or medications that cause symptoms or irritate the lining of the stomach. Our gastroenterologists can connect patients and their families with our specially trained dietitians who can provide advice on what food to eat and avoid while treating gastritis. Generally, treatment for gastritis involves antacids and other medications aimed at reducing stomach acid, relieving symptoms, and promoting the healing of the stomach lining. If gastritis is related to an illness or infection, then that problem should be treated as well. If gastritis is caused by H. pylori, the most common treatment is a triple therapy that combines two antibiotics with a proton pump inhibitor (PPI). Learn more about H. pylori.

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder that occurs when gastric acid from the stomach abnormally flows back up into the esophagus. Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux happens when the lower esophageal sphincter (LES) muscle relaxes abnormally, allowing stomach contents to go back up the esophagus. The LES is a muscle located at the bottom of the esophagus that opens to let food into the stomach and closes to keep food in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn. Vomiting occurs when stomach contents go all the way up the esophagus and heartburn occurs when stomach contents only go part of the way up the esophagus. GERD is very common in infants, and is the most common cause of vomiting during infancy, as infants are more likely to experience weakness of the LES muscle, allowing it to relax when it should remain shut. What is the difference between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD)? Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus. Everyone has Gastroesophageal reflux (GER) GERD from time to time. Anyone who has ever burped and had an acid taste in their mouth has had reflux. The lower esophageal sphincter occasionally relaxes at inopportune times, and usually, all your child will experience is a bad taste in the mouth, or a mild, momentary feeling of heartburn. GER occurs in more than two-thirds of healthy infants, and half of these infants experience regurgitation or “spitting up” that spontaneously resolves without medication by approximately 1 year of age. When the reflux causes intolerable discomfort or complications, patients should be evaluated by a doctor for gastroesophageal reflux disease (GERD). Your child may be experiencing gastroesophageal reflux disease (GERD) if they experience: Symptoms that prevent them from feeding, include vomiting, coughing, or difficulty breathing. Signs & symptoms of GER more than 2 times a week over a few months GER for more than 12 to 14 months

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WHAT IS PEDIATRIC GASTROENTEROLOGY?

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PEDIATRIC GASTROENTEROLOGY FREQUENTLY ASKED QUESTIONS

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How Is Endoscopy Performed in Chidren?

How Is Colonoscopy Performed in children?