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Paediatric Gastroenterology

Paediatric Gastroenterology. Dr Shoana Quinn September 2009 Trinity College Dublin. Paediatric Gastroenterology. Recurrent Abdominal Pain of Childhood Constipation Gastroesophageal Reflux. Recurrent Abdominal Pain of Childhood. Very Common Especially 7-14 years Periumbilical

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Paediatric Gastroenterology

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  1. Paediatric Gastroenterology Dr Shoana Quinn September 2009 Trinity College Dublin

  2. Paediatric Gastroenterology • Recurrent Abdominal Pain of Childhood • Constipation • Gastroesophageal Reflux

  3. Recurrent Abdominal Pain of Childhood • Very Common • Especially 7-14 years • Periumbilical • Present all the time • Missing school • Sensitive, perfectionistic children

  4. RAP • Severe, doubled over • Pallor • Persistent for months • Well in between episodes • No nocturnal symptoms • Reassurance • Minimal Investigation

  5. Constipation • Very Common • Hard, sore stools • Frequency prior to toilet training is very variable • Withholding • Faecal overload and overflow • Perianal tears

  6. History and Examination • Withholding behaviour often mistaken for straining • Bright red blood on stool or on wiping • Children unaware of stool, not behavioural • Faecal masses on palpation of abdomen • Perianal inspection. Rectal examination should never be performed in paediatrics

  7. Constipation treatment • Child needs to gain confidence • Get rid of hard impacted stool • Soften stool adequately so not sore • Regular toileting with foot support • Continue treatment through toilet training as this is often a time of trouble. • Star charts and reinforcement

  8. Constipation treatment • Bisacodyl (Dulcolax) for 3 days AM • Liquid Paraffin at night • Lactulose if younger than 1 year • Movicol • Suppositories should only be used as last resort • Diet in children not a big contribution, excess milk can cause constipation and iron deficiency

  9. Ddx Constipation • Hirschsprung Disease aganglionosis in intramuscular and submucous plexuses of the bowel • Always involves anus and extends proximally • Surgical treatment • Risk of enterocolitis

  10. Gastroesophageal Reflux • GOR a normal physiological event • 50% children in first 3 months • Fewer than 5% age 1 year • Well, thriving, happy child • Happy to feed post vomit

  11. GOR • Clinical diagnosis • pH probe probably only useful investigation but need consistent operator and acidic refluxate • Barium studies are never appropriate

  12. Management of GOR • Parental reassurance and centiles • Lie flat after a feed • Feed thickeners? • No medications

  13. Gastrooesophageal Reflux Disease • Completely different condition • Characterised by food refusal, haematemesis, irritability and failure to thrive • Clinical diagnosis unless suspicion of obstruction • Trial of PPI then endoscopy and biopsy • Fundoplication vs longterm PPIs

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