Pediatric gastroenterology is the branch of medicine that deals with the management of disorders of the childhood digestive system (esophagus, stomach, small and large bowel) as well as supporting organs (liver and pancreas).
At American Hospital, Dubai, the pediatric gastroenterology division, led by Dr. Dalia Belsha, has the expertise in managing the full range of pediatric gastroenterological and nutritional problems. These include:
To reach to the right diagnosis we offer the state of art investigations and treatment including pediatric upper GI endoscopy, colonoscopy, biopsies, capsule endoscopy, PEG (gastrostomy placement), MRI of the small bowel (MR enterocolysis), MRCP, urea and hydrogen breath test, colonic transit studies, ph impedance study, and full-thickness biopsy. Our team works closely as an integral unit offering complete assessment and management of common and complex pediatric GI problems. Members of our team include consultant pediatric gastroenterologist, consultant pediatric surgeons, consultant pediatric anesthetist, gastro nurses, endoscopy nurse, dieticians, speech and language therapist, psychologist, consultant radiologist, and consultant pathologist.
Inflammatory bowel diseases (IBD) is a group of diseases that cause long-term inflammation of the intestines (bowel). These can affect only the large bowel (ulcerative colitis) or any part of the entire digestive system (Crohn's disease). Symptoms of IBD include frequent bowel movement that may contain blood or mucous, abdominal pain, fever, mouth ulcers, weight loss, and fatigue. All patients with suspected IBD will need endoscopy (gastroscopy and colonoscopy) to confirm the diagnosis. Other modalities (MRE and capsule endoscopy) are used to complete the assessment of the GI tract IBD is treated mainly with medications and sometimes with a change in diet. Celiac disease is a disorder where there is permanent gut hypersensitivity to gluten. Symptoms include diarrhea (loose stool), poor growth, or stomach bloating/pain. Although there is a useful blood test which will suggest the diagnosis, an intestinal biopsy and gastroscopy is the ideal method to confirm the diagnosis and needs to be performed before any change in the diet. It is important to get a firm diagnosis prior to excluding diet as treatment is life- long. The treatment is to stop eating all foods with gluten in them, like bread and pasta. Complex gut problems in some of the children can happen. This is when bowel that doesn’t function properly or has short bowel (by birth or because of surgery). Those children will need assisted nutrition to support their growth. This could be given via tube (gastrostomies) or via liquid nutrition in the vessel (TPN). Faltered growth is defined as a child whose weight or height or both are falling across the growth chart. These cases are best treated by a combined assessment of the hormone doctor (pediatric endocrinologist) and the gastroenterologist to establish the cause and treat accordingly. The presence of blood in vomit or in the stool is a common reason for children to be referred for gastroenterologist/endoscopy. The blood may be red or sometimes will become tarry black. The cause will depend on the age of the child and can be due to mild causes but could be serious as well. The best method of finding the reason behind is an assessment by the pediatric gastroenterologist followed by likely gastroscopy and/or colonoscopy.Inflammatory Bowel Disease
Celiac Disease
Intestinal Failure
Faltered Growth
Blood in vomiting or stool
This is a day case camera test which allows the gastroenterologist to see inside the food pipe (esophagus), stomach, and the first part of the small intestine (duodenum) and take a small tissue sample (biopsies) if needed. This happens while the child is deeply sedated or asleep and in a child-friendly environment. This is a procedure that allows the gastroenterologist to see inside your child's bowel and examine the surfaces directly and take biopsies (samples of tissue). Treatment of conditions can also be undertaken like removal of polyp (extra growth) and manual evacuation (removal of fecal material) while the child is deeply sedated or asleep. The best way to look at the liver diseases and to assess the extent of the disease is a biopsy. It is performed by inserting a needle into the liver guided by images (ultrasound) through the skin and taking a small sample of liver tissue. Examination of the sample under the microscope can show what damage or what type of disease is present. Following the procedure, children are admitted to our ward for overnight observation. A pH/Impedance study is a test designed to see if your child has reflux (the contents of the stomach coming back out the stomach into the esophagus) and to assess the severity of it and if it goes back to his windpipe. A pH/Impedance probe is a thin, flexible tube that is inserted into the nose and down the back of the throat. The probe is usually placed under sedation or while the child is asleep (general anesthesia). This is a radiographic test of the small intestine. Your child will have to drink milk/juice with added tasteless liquid (gastrografin/barium etc). This special liquid is visible on the X-ray. Images are then at intervals to demonstrate different parts of the gastrointestinal canal. It is done to see if there are problems with the esophagus (like hiatus hernia, reflux), or small intestine (like malrotation, Crohn’s disease) or the large bowel (like stricture or a ganglionic segment). This is a test to examine the small intestine. Your child will be asked to drink a good amount of special liquid prior to the test then lie on a special table that moves in a tunnel-shaped scanner. Images of their small intestine and liver can be taken. The scan may take around 20-30 minutes and is a bit noisy but is completely painless. Younger children (less than 10 years of age use a different technique called contrast studies, see above).Gastroscopy
Colonoscopy
Liver Biopsy
Ph /Impedance study
Contrast studies
Abdomen MRI (magnetic resonance imaging)
